RESUMO
Roux-en-Y fistulojejunostomy (RYFJ) has been proposed as a surgical option for the treatment of a chronic fistula after sleeve gastrectomy but can be technically challenging. The robotic approach in bariatric surgery has emerged as a new rapidly evolving technology and allows performing more complex surgical procedures. Here we present the case of a 42-year-old man referred to our university tertiary center for a chronic gastro-colic fistula after laparoscopic SG who underwent a salvage robotic RYFJ. The aim of this video is to present our management of a chronic gastro-colic fistula after laparoscopic SG demonstrating the technical advantages of a robotic approach to a RYFJ.
Assuntos
Cólica , Derivação Gástrica , Laparoscopia , Obesidade Mórbida , Procedimentos Cirúrgicos Robóticos , Adulto , Gastrectomia/efeitos adversos , Derivação Gástrica/efeitos adversos , Humanos , Masculino , Obesidade Mórbida/cirurgia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
The alimentary limb has been proposed to be a key driver of the weight-loss-independent metabolic improvements that occur upon bariatric surgery. However, the one anastomosis gastric bypass (OAGB) procedure, consisting of one long biliary limb and a short common limb, induces similar beneficial metabolic effects compared to Roux-en-Y Gastric Bypass (RYGB) in humans, despite the lack of an alimentary limb. The aim of this study was to assess the role of the length of biliary and common limbs in the weight loss and metabolic effects that occur upon OAGB. OAGB and sham surgery, with or without modifications of the length of either the biliary limb or the common limb, were performed in Gottingen minipigs. Weight loss, metabolic changes, and the effects on plasma and intestinal bile acids (BAs) were assessed 15 days after surgery. OAGB significantly decreased body weight, improved glucose homeostasis, increased postprandial GLP-1 and fasting plasma BAs, and qualitatively changed the intestinal BA species composition. Resection of the biliary limb prevented the body weight loss effects of OAGB and attenuated the postprandial GLP-1 increase. Improvements in glucose homeostasis along with changes in plasma and intestinal BAs occurred after OAGB regardless of the biliary limb length. Resection of only the common limb reproduced the glucose homeostasis effects and the changes in intestinal BAs. Our results suggest that the changes in glucose metabolism and BAs after OAGB are mainly mediated by the length of the common limb, whereas the length of the biliary limb contributes to body weight loss.NEW & NOTEWORTHY Common limb mediates postprandial glucose metabolism change after gastric bypass whereas biliary limb contributes to weight loss.
Assuntos
Ácidos e Sais Biliares/metabolismo , Sistema Biliar/patologia , Ducto Colédoco/patologia , Derivação Gástrica/métodos , Glucose/metabolismo , Anastomose Cirúrgica/métodos , Animais , Ácidos e Sais Biliares/sangue , Sistema Biliar/metabolismo , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Glicemia/metabolismo , Ducto Colédoco/metabolismo , Ducto Colédoco/cirurgia , Feminino , Modelos Animais , Obesidade Mórbida/metabolismo , Obesidade Mórbida/cirurgia , Período Pós-Prandial , Distribuição Aleatória , Suínos , Porco Miniatura , Redução de Peso/fisiologiaRESUMO
After Roux-en-Y gastric bypass, leaks from gastro-jejunostomies represent serious morbidity. Situations where large defects develop on small gastric pouches present particular surgical challenges. Here, we report the case of a 43-year-old female who presents with a large gastric leak after conversion of sleeve gastrectomy to Roux-en-Y gastric bypass due to staple lines having crossed. The aim of this video is to present the management of gastrojejunal leak after Roux-en-Y gastric bypass and technical features of circular stapled laparoscopic oesophagojejunal anastomosis.
