1,721,043 research outputs found
Complications of staple line and anastomoses following laparoscopic bariatric surgery
Full text linkWith over 600 million people being obese, and given the scientific demonstration of the advantages of surgical treatment, bariatric surgery is on the rise. The promising long-term results in terms of weight loss, and particularly in relation to comorbidities and the control/cure rate, mean that the number of procedures performed in all countries remains high. However, the risk of potentially complex or fatal complications, though small, is present and is related to the procedures per se. This review is a guide for bariatric and/or general surgeons, offering a complete overview of the pathogenesis of anastomosis and staple line following the most common laparoscopic bariatric procedures: sleeve gastrectomy, gastric bypass, and mini-gastric bypass. The review is divided according to the procedure and the complications (leak, bleeding and stenosis), and evaluates all the factors that can potentially improve or worsen the complication rate, representing a “unicum” in the present literature on bariatric surgery
“Consumo di bevande alcooliche e livelli di alcolemia prima e dopo Sleeve Gastrectomy (SG) Studio prospettico comparativo”
No full textPurpose The aim of this original research is to evaluate the effect of SG on alcohol intake symptoms, blood alcohol content (BAC), and alcohol metabolite levels. Methods At 0–6–12 months after SG, BAC of patients was measured at 0, 15, 30, and 60 min, and then every 30 min, and urinary metabolite (ethanol and acetaldehyde) levels were measured 2 h after consuming a standard red wine drink. Symptoms perceived by patients were evaluated using symptom alcoholization post-obesity surgery scores. Results Thirty obese patients (12 men/18 women; mean body mass index, 44 ± 4 kg/m2) who underwent SG were enrolled in this study. At 12 months after SG, no alcohol use disorder was observed and BAC tended to peak after 15 min, with alcohol intoxication symptoms (nausea/vomiting, flushing, and diaphoresis), and return to zero after 90 min of wine intake. Ethanol and acetaldehyde levels were significantly different at 12 months compared with the levels at time 0 (p < 0.05). Conclusions Following SG, patients exhibit a high BAC at 15 min after moderate alcohol consumption accompanied with increased metabolite excretion and intoxication symptom
IBC-Ox26 Concomitant hiatal hernia repair during bariatric surgery: is it the reinforcement making the difference?
No full textUnpredictable evolution of a 20-years history of a bariatric patient. Case report of a migrated gastric band after redo gastric bypass
No full textIntroduction: morbid obesity is a chronic disease, with resistance to multiple therapies. Bariatric surgery is the most efficient nowadays treatment, but with a certain price when we speak of surgeon’s efforts, patient’s compliance and tolerance, available technology and long term evolution. Materials: we present the case of 20 years evolution of a female obese patient, with multiple, sequential bariatric minimally-invasive interventions: intragastric balloon, gastric banding, gastric bypass (GBP), banding positioning on GBP, all complicated. Last attempt to treat weight regain was laparoscopic positioning of an adjustable banding over a failed gastric bypass in 2015, complicated 12 months after by acute intestinal occlusion due to band migration, leading to open emergency band removal, wound dehiscence and finally incisional hernia. Results: after multiple interventions, the patient has a BMI of 38 kg/m2, large incisional hernia, depression, over a non-satisfactory gastric bypass. Conclusion: bariatric surgery has some limitations in case of patient’s non-compliance and bad-luck, even with persistent, experienced tailored bariatric treatment. Non-responsive obese patients should be considered as possible subcategory of long-term outcomes
Leaks after laparoscopic sleeve gastrectomy. Overview of pathogenesis and risk factors
No full textBackground: Leak is the second most common cause of death after bariatric surgery. The leak rate after laparoscopic sleeve gastrectomy (LSG) ranges between 1.1 and 5.3 %. The aim of the paper is to provide an overview of the current pathogenic and promoting factors of leakage after LSG on the basis of recent literature review and to report the evidence based preventive measures.
Methods: Risk factors and pathogenesis of leakage after LSG were examined based on an extensive review of literature and evidence based analysis of the most recent published studies using Oxford centre for evidence-based medicine, 2011, levels of evidence.
Results: Pathogenesis of leakage after LSG can be attributed to mechanical or ischemic causes. Many factors can predispose to leakage after LSG which are either technically related or patient related. Awareness of these predisposing factors and technical tips may decrease the incidence of leakage.
Conclusions: This review reports factors promoting leak and gives technical recommendations to avoid leak after LSG based on the available evidence and expert consensus which encompasses: (1) use a bougie size ≥40 Fr, EL:1, (2) begin the gastric transection 5-6 cm from the pylorus, EL:2-3, (3) use appropriate cartridge colors from antrum to fundus, EL:1, (4) reinforce the staple line with buttress material, EL:1, (5) follow a proper staple line, (6) remove the crotch staples, EL:4, (7) maintain proper traction on the stomach before firing, (8) stay away from the angle of His at least 1 cm, EL:1, (9) check the bleeding from the staple line, (10) perform an intraoperative methylene blue test, EL:4
Alcohol consumption after laparoscopic sleeve gastrectomy. 1-year results
No full textAbstract
Introduction Laparoscopic sleeve gastrectomy (SG) represents, at present, the most performed bariatric procedure worldwide
with excellent long-term results on weight loss and comorbidities control. After the gastrectomy procedure, together with
hormonal modification, several changes in taste and habits occur, including the potential modification in alcohol consumption.
The aim of this prospective study was to determine the frequency and the amount of alcohol use before and after SG using
a modified version of the Alcohol Use Disorder Identification Test (AUDIT) at 1-year follow-up and eventually to evaluate
relationships between different ages and sexes.
Materials and methods A total of 142 patients were prospectively enrolled and evaluated before and 1 year after SG with a
modified AUDIT. The exclusion criteria were as follows: history of alcohol abuse, presence of psychopathology or cognitive
impairments, diabetes mellitus type II decompensated, or previous gastrointestinal, liver, and pancreatic resective surgery.
Subgroup analyses were performed between male and female and between under and over 40 years old.
Results The median AUDIT score decreased from 2.70 (range 1–18) before surgery to 1.38 (range 1–7) after 1 year of SG,
indicating a marked reduction in alcohol use. The most consumed alcoholic drink was beer (36.6%/n = 52) while after surgery
the consumption of beer decreased considerably (21.1%/n = 30). The frequency of alcohol consumption also decreased: at
baseline 45% of patients consumed alcoholic drinks “from 2 to 4 times per month”, whereas 26 and 39.4% consumed alcohol
“never” and “less than once a month,” respectively. After surgery, nobody consumed more then six alcoholic drinks. No
differences were found between the subgroups in terms of alcohol consumption and social behavior.
Conclusions The alcohol preference is modified and decreased 1 year after SG and this could be related to the strict nutritional
follow-up and to the hormonal changes. Studies with large samples and long-term follow-up are needed to confirm our
Surgical approach for totally implantable venous access devices: consideration after 753 consecutive procedures.
No full text[No abstract available
Gastric Bypass as Conversion from Abandoned Bariatric Procedures: Gastric Plication, Banding or Pacemaker, Toga or Banded Vertical Gastroplasty. A Video Remix
No full textIntroduction: recently, increased numbers of revision bariatric procedures
are reported worldwide, especially due to insufficient
weight loss or weight regain. Some of former bariatric procedures
are currently abandoned or anecdotally used due to long-term
failure and increased incidence of revision surgeries needed.
Objectives: To evaluate the role of laparoscopic gastric bypass LGBP in
the treatment of failure of previous, abandoned bariatric procedures.
Methods: A video remix of laparoscopic conversion from gastric
banding, gastric plication, gastric pacemaker, TOGA or banded
vertical gastroplasty is presented. Patients operated between 1997
and 2010 with different bariatric procedures were converted for
weight regain, comorbidities recurrence, unsatisfactory results.
Intraoperative difficulties, adhesiolisys, different prosthesis removal,
unexpected situations are briefly presented.
Results: no conversion and no mortality were recorded.
Conversion to LGBP was efficient and safe in all revision procedures,
with further weight loss recorded. An important improvement
of the patients’ symptoms and satisfaction was achieved 6
months postoperatively, with suspension of medical therapy, maintained
one year after intervention.Conclusions: conversion in GBP is actually the best option of
treatment in case of weight regain after abandoned, former bariatric
procedures
Severe events related to use of stents in bariatric surgical complications
Full text linkIntroduction: Endoscopic self-expandable stents are emerging as safe and effective options for the treatment of bariatric
surgery complications. Our aim is to report 3 cases of severe complications after self-expandable stent implantation.
Case Description: A retrospective database analysis showed 14 major complications over the past 400 bariatric procedures
(3.5%); 8 of them were managed conservatively. Three cases of unusual severe complications after self-expandable stent
implantation were observed. In case 1 (leak after resleeving), the self-expandable stent migrated twice and caused an
esophageal stenosis, which was treated by endoscopic dilation. Three months later, the stenosis recurred and the patient was
a candidate for distal esophagectomy. In case 2 (gastrojejunal stricture after Roux-en-Y gastric bypass), the endoscopic dilation
was complicated by perforation and treated with a self-expandable stent. The patient required an emergency laparoscopy to
remove the stent that had migrated into the ileum. After 1 month, gastrojejunal stenosis recurred and the patient underwent
laparoscopic revision of the anastomosis. In case 3 (leak after vertical banded gastroplasty [VBG]–Roux-en-Y gastric bypass
conversion), the self-expandable stent migrated twice and caused an esophageal-pleural fistula managed with a new stent.
Discussion: Bariatric surgeons have to balance the possible advantages of self-expandable stents on a case-by-case basis.
Complications of endoscopic stents can be life-threatening and are underestimated and under-reported in the literatur
Persistent fistula after sleeve gastrectomy: a chronic dilemma
Full text linkNu există limită de timp în ceea ce priveşte apariţia fistulelor după sleeve gastrectomy LSG, iar cele cu debut tardiv pot evolua către fistule persistente, cronice. Scopul acestui studiu retrospectiv a fost de a analiza incidenţa, tratamentul şi urmările după acestea, tratate într-un Centru de Excelenţă de chirurgie bariatrică şi de a dezvolta un tratament standard. Materiale şi Metode: între 2011-2018, 9 cazuri de fistule postoperatorii au apărut după un număr total de 1365 LSG (0,65%), 7 prezentând debut tardiv (minim 10 zile de la operaţie). Au fost identificate şi analizate fistulele cronice, persistente, inclusiv o fistulă gastro-bronhială şi una gastro-cutanată. Rezultate: prezentăm 3 cazuri particulare de fistule foarte tardive, cronice de tip III (fistule complexe), cu debut variind de la 6 până la 84 luni după LSG, şi tratamentul acestora (conservativ, radiologie şi/sau endoscopie intervenţională, chirurgical). Concluzii: managementul fistulelor tardive, cronice de tip III, este variabil, nestandardizat şi ar trebui planificat pe baza evoluţiei clinice, momentul diagnosticului, resursele disponibile şi expertiza locală. Un centru bariatric de excelenţă poate garanta un diagnostic şi tratament mai adecvat, pe baza resurselor şi a posibilităţilor existente.Background: There is no time limit for the occurrence of leaks after sleeve gastrectomy LSG, and very late ones might evolve versus persistent, chronic fistulas. The aim of this retrospective study was to analyze the incidence, treatment and outcomes of persistent, chronic fistulas occurred or treated in a bariatric Center of Excellence IFSO-EC (CoE) and to establish a standardized approach. Materials Methods: between 2011-2018, nine cases of postoperative leaks occurred on a total of 1365 LSG performed (0.65%), 7 of them having late presentations (onset over 10 days postoperative). Chronic, persistent fistulas were identified and analyzed, including one gastro-bronchial and one gastro-cutaneous fistulas. Results: We present three peculiar cases of very late, chronic type III fistulas, with onset at 6-84 months after primary LSG and their management, including conservative, interventional radiology and endoscopy and surgical therapies. Conclusions: the management of late, chronic type III fistula is variable, with no standard algorithm to follow, but it should be planned based on the clinical evaluation, time of diagnosis, available resources, multidisciplinary approach and expertise. This emphasises again the necessity of a bariatric CoE that can guarantee a better diagnose and treatment, based on the use of wide, available resources, both professional and material
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