Journal of Gastric Surgery
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Massive choleperitoneum three months after mini-gastric bypass for morbid obesity: what every emergency surgeon should be prepared to face. A case report.
Full text linkBackground:
Surgery for morbid obesity has spread worldwide, to the point that more than half a million people are operated on each year. As a result, significant numbers of people are living with a new anatomical condition. A mini-gastric bypass is a relatively new bariatric procedure that has gained popularity because of its simplicity and efficacy. Leak rate after this procedure is relatively low (on the order of 1.6%), but marginal ulcer of gastrojejunal anastomosis, if undetected, may lead to leak development.
No cases of delayed massive choleperitoneum caused by an almost complete disruption of gastrojejunal anastomosis after mini-gastric bypass have yet been described.
Case presentation:
We describe here the case of a 51-year-old woman who presented at the emergency department three months after a mini-gastric bypass with acute abdomen caused by massive choleperitoneum due to an almost complete disruption of gastrojejunal anastomosis.
The patient underwent an emergency conversion to a Roux-en-Y laparoscopic gastric bypass with associated re-gastrectomy. The postoperative period was characterized by fever due to an infected left pleural effusion, which required treatment with chest tube placement. The patient was discharged three weeks after the operation, in good condition. Six-month follow-up was regular.
Conclusions:
If suspected, the possibility of marginal ulcer should be investigated as soon as possible. When possible, every obese patient who has complications should be referred to a bariatric surgery department, but each emergency surgeon must be aware of these conditions to be able to treat them optimally
The use of indocyanine green in bariatric surgery: A systematic review
Full text linkFluorescence-guided surgery is a recently developed technique in minimally invasive surgery in which a fluorescent dye is used to complement the surgeon’s judgment in making real-time intraoperative assessment of organ vascularization and proper tissue perfusion. This technique has been adopted in several different surgical subspecialties with positive results, particularly in hepatobiliary and colorectal surgery. More recently, it has also been applied in bariatric surgery, with the aim of reducing the incidence of leaks. This paper reviews the relevant literature on the topic
Technology spreading in healthcare: a novel era in medicine and surgery?
Full text linkSurgery and technological innovation have begun to move at the speed of light, with innovations and discoveries such as virtual reality, robotic systems, navigation surgery, and 5G networks radically revolutionizing the surgical world as well as the medical world in general, bringing significant benefits for healthcare professionals and patients alike. Technology will increasingly be a crucial element in surgical and medical development. This new therapeutic approach aims to enhance human–computer interaction by putting a new “patient” figure at its center. Multiple studies will be needed to demonstrate new advanced technological systems’ noninferiority to traditional patient approaches. Scientific societies, hospitals, and healthcare professionals cannot be found ill prepared for this revolution
Sarcina ventriculi: A Rare Case of Life-Threatening Perforated Gastric Ulcer and Review of Literature
Full text linkSarcina ventriculi is a gram-positive anaerobic bacterium reported rarely in patients with a history of gastrointestinal surgery and delayed gastric emptying. Sarcina has been implicated in the development of gastric ulcers, emphysematous gastritis, and gastric perforation. So far, less than 30 cases of Sarcina isolated from gastric specimens have been reported, including 3 cases associated with life-threatening illness:emphysematous gastritis and gastric perforation. Herein, we report a case of a 58-yearold woman with history of gastric surgery who presented for evaluation of persistent gastric pain and incurable ulcer. She underwent total gastrectomy, and the resected stomach demonstrated a perforated ulcer with the presence of Sarcina microorganisms.We also report a second case of a 56-year-old woman with history of NSAID use who presented with gastric outlet obstruction. The gastric biopsy identified concurrent Helicobacter pylori and Sarcina. Given Sarcina's association with emphysematous gastritis and gastric perforation, its identification on gastric biopsies should be clearly stated in pathology reports and, depending on the clinical scenario, prompt clinicians to add adjunctive antimicrobials to anti-ulcer therapeutic regimens
Esophagogastric premalignant conditions. A literature review
Full text linkEsophagogastric cancers are serious malignancies with high mortality and low overall survival for advanced tumors. Detection of premalignant lesions and early treatment of malignant lesions are of paramount importance. Precancerous esophagogastric conditions develop from interaction between environmental and genetic factors. Chronic irritation and inflammation may result in metaplasia, increased mutations, cellularatypia, and altered function (dysplasia). Helicobacter pylori (HP) infection is one of the most important risk factors for gastric carcinogenesis, but other environmental factors (e.g. alcohol, tobacco, nitrites, infection) and autoimmune disorders play a role as well. Esophageal adenocarcinoma (EAC) usually arises in the distal esophagus and is linked to obesity, gastroesophageal reflux disease (GERD) and Barrett’s esophagus (BE). Squamous cell carcinoma (ESCC) typically occurs in the presence of risk factors causing chronic inflammation (e.g. tobacco, alcohol abuse, achalasia, tylosis). Highquality endoscopic imaging is of primary importance in the diagnosis and assessment of premalignant and early malignant esophagogastric lesions. Biological markers such as aberrant p53 protein expression may be associated with increased risk of malignant transformation of precancerous lesions; however, none of those biomarkers has been validated for either diagnosis or risk stratification yet
A Case of Gastroesophageal Cancer after Laparoscopic Sleeve Gastrectomy
Full text linkGastric cancer has been reported in relatively few cases after sleeve gastrectomy, which has become a common bariatric procedure. In this paper, we present a 58-year-old woman diagnosed with gastric cancer by esophagogastroduodenoscopy (EGD) 4 years after sleeve gastrectomy. For that, she underwent distal esophagectomy and total gastrectomy with Roux-en-Y esophagojejunostomy. Preoperative endoscopy is recommended before planning surgery in patients with gastroesophageal reflux symptoms. In addition, annual EGD should be considered after sleeve gastrectomy in patients with risk factors for gastric cancer
Gastric carcinosarcoma with rhabdomyosarcomatous differentiation: a case report and literature review
Full text linkGastric carcinosarcoma with rhabdomyosarcomatous differentiation is a rare tumor. Herein, we report the case of a 34-year-old man with a history of dysphagia, upper abdominal fullness, and poor appetite. Endoscopic findings showed a large friable mass that originated from the gastric cardia and lesser curvature of the high body. Consequently, radical total gastrectomy with Roux-en-Y esophagojejunostomy was performed. Histopathological analysis of the resected specimen revealed that the mass had invaded the serosa without regional lymph node metastasis; moreover, the tumor was positive for desmin and myogenin. Finally, we conclude this report with literature review and discussion
Laparoscopic resection for gastric GISTs: surgical and long-term outcomes of 133 cases
Full text linkBackground
It aims to evaluate the surgical efficacy and long-term survival of different laparoscopic surgeries for gastric GISTs.
Methods
From a prospectively collected database, 133 patients with primary gastric GISTs undergoing laparoscopic surgery were selected from January 2008 to December 2014. They were divided into three groups according to the different operations that were performed, including laparoscopic gastric wedge resection (LWR Group, n=103), laparoscopic subtotal gastrectomy (LSG Group, n=18) and laparoscopic total gastrectomy (LTG group, n=12). Clinicopathological features and short- and long-term outcomes were analyzed retrospectively.
Results
All patients had received R0 resection. There were no differences among the three groups in age, BMI or NIH risk classification. Compared with the LSG group and LTG group, the LWR group had a shorter operative time, less blood loss, fewer operative complications and shorter time to ground activities, semi-liquid diet and hospital stay (P<0.05). There was no statistically significant difference in time to first flatus and liquid diet or in the rate of postoperative complications (P<0.05). In the patients with a large tumor (size≥5 cm), LWR was significantly associated with shorter operative time, less blood loss and shorter hospital stay compared with the laparoscopic gastric non-wedge resection (N-LWR) (P<0.05). The median follow-up was 30 months, with 4 cases of recurrence and 3 deaths. The 5-year cumulative survival rate was similar among the three groups (P>0.05).
Conclusions
Compared with LSG and LTG, more favorable minimally invasive results can be achieved from LWR for gastric GISTs, which may be the optimal surgical procedure
Metastatic leiomyosarcoma of the excluded stomach: a case report
Full text linkBackground:Leiomyosarcoma (LMS) represents about 1% of primary malignancies of the stomach, usually evolves with hepatic implants in 2-thirds of cases, and the outcome is frequently poor. With an insidious course, late diagnosis and misdiagnosis with other gastric neoplasia occur. Immunohistochemical evaluations are mandatory to confirm the diagnostic hypothesis. Surgical resection has been the more effective treatment ofgastric LMS; however, recurrences after resections and distant metastases may develop in up to 50% of the patients. Doxorubicin, gemcitabine, and docetaxel are therapeutic options, with variable responses.Case presentation:The 52-year-old male herein described with a diagnosis of LMS in the gastric pouch and liver metastasis underwent a Roux-en-Y bypass to treat morbid obesity more than a decade ago. Persistent abdominal pain was a unique symptom, and he had liver metastasis at diagnosis. The initial hypothesis was a metastatic gastrointestinal stromal tumor (GIST) of the excluded stomach and the patient underwent a schedule with imatinib without significant response. After a complete revision of the anatomopathological findings,the patient underwent a new biopsy of the gastric mass, and the immunohistochemical data were consistent with LMS. Then doxorubicin replaced imatinib, later changed by gemcitabine associated with docetaxel. As last control found lesions in the central nervous system, he is under radiotherapy sessions.Conclusion:The diagnosis of gastric LMS often occurs at late stages because of the insidious clinical course. The rate of liver metastasis at diagnosis is high. Besides, the relatively poor response to the alternative management for non-surgical stages of the disease yields severe outcomes
Laparoscopic adjustable gastric banding’s multiple complications: when complications arise even after 30 years, a case report.
Full text linkLaparoscopic adjustable gastric banding (LAGB) is a popular bariatric surgical procedure. The introduction of laparoscopy has increased the use of this procedure, making it the most commonly performed bariatric surgery. Patients undergoing LAGB have achieved satisfactory results in terms of weight loss, a reduction in co-morbidities, and improved quality of life. Nonetheless, complications with LAGB are well documented and include migration, erosion, prolapse, infection, pouch dilation, gastric perforation, and most commonly, lack of weight loss following the failure of the procedure. This case report presents a patient with slippage and pouch dilation, erosion of the stomach, and port site problems, including infection, occurring 28 years after LAGB