Resectional One Anastomosis Gastric Bypass/Mini Gastric Bypass as a Novel Option for Revision of Restrictive Procedures: Preliminary Results.

Background: Revisional surgery is becoming a common and challenging practice in bariatric centers. The aim of this study was to evaluate resectional one anastomosis gastric bypass/mini gastric bypass (R-OAGB/MGB) as a revisional procedure. Methods: From January 2016 to February 2017, data on 21 consecutive patients undergoing R-OAGB/MGB for weight loss failure after primary restrictive procedures were prospectively collected and analysed. Results: Mean age was 39 ± 12 years (18-65), and 11 (52.3%) were women. The mean operative time was 96.4 ± 20.9 min (range, 122-80), and the mean postoperative stay was 47.8 ± 7.4 hours (range, 36-73). There were no deaths and no procedure-related complications. The mean body mass index (BMI) decreased from 42.9 ± 6.5 at the time of R-OAGB/MGB to 28.5 ± 4 at the 12-month follow-up. At that time point, the mean percentage of BMI loss (%EBL) and the mean percentage of total body weight loss (%TWL) reached 81.6 ± 0.17% and 35 ± 0.01%, respectively. Conclusion: R-OAGB/MGB was technically straightforward, effective, and safe in this at-surgical risk population. R-OAGB/MGB should be added to the armamentarium of revisional bariatric procedures considering its technical aspects and the potential advantage on weight loss.

Biliary ischemia following embolization of a pseudoaneurysm after pancreaticoduodenectomy.

AIM: To report an uncommon consequence of hepatic artery occlusion in the management of a bleeding pseudoaneurysm following pancreaticoduodenectomy. IMAGING: Analysis of a case involving a single patient in which a bleeding pseudoaneurysm of the gastroduodenal arterial stump following pancreaticoduodenectomy was treated by transcatheter arterial embolization. CASE REPORT: Effective hemostasis necessitated interruption of the hepatic arterial flow and was complicated by biliary ischemia and intrahepatic biloma.

Chondroblastoma of the lumbar spine. Report of two cases and review of the literature.

Chondroblastoma is a benign cartilaginous neoplasm that generally affects the appendicular skeleton. Twenty-six cases of spinal chondroblastoma have been reported in the past 50 years, only six of which were located in the lumbar region. The authors report two cases involving this exceptional location. In both patients, low-back pain, in the absence of radicular pain, was the presenting symptom. In both cases, plain radiography and computerized tomography scanning revealed an osteolytic lesion surrounded by marginal sclerosis. Magnetic resonance imaging allowed the authors to study the tumor's local extension. Examination of a percutaneous fluoroscopy-guided biopsy sample revealed the following typical histological features of chondroblastoma: chondroid tissue, focally alternating with cellular areas, and no nuclear atypia or pleomorphism. To reduce the risk of local recurrence, vertebrectomy and anterior-posterior fusion were performed in both cases. In one case, a structural lumbar scoliosis was corrected during the posterior procedure. There was no postoperative complication. No recurrence was observed during the 3- to 6-year follow-up period. The surgery-related results were deemed successful. Although exceptional, the diagnosis of chondroblastoma is possible in lesions involving the lumbar spine. Other spinal locations are described in the literature, and frequency of recurrence is stressed. A vertebrectomy is advised to reduce the risk of local recurrence.

Laparoscopic sleeve gastrectomy for mildly obese patients (Body Mass Index of 30 <35 kg/m²): operative outcome and short-term results.

BACKGROUND: Data concerning laparoscopic sleeve gastrectomy (LSG) in mild obesity are under investigation. AIM/OBJECTIVE: May 2010 to May 2012, 122 consecutive patients with preoperative body mass index (BMI) of 33 ± 2.5 kg/m² (range 30-34.9) undergoing LSG were studied. Mean age was 33 ± 10 years (range 15-60), and 105 (86%) were women. Mean preoperative weight was 91 ± 9.7 kg (range 66-121), and preoperative excess weight was 30 ± 6.7 kg (range 19-43). Comorbidities were detected in 44 (36%) patients. RESULTS: Mean operative time was 58 ± 15 min (range 40-95), and postoperative stay was 1.8 ± 0.19 days (range 1.5-3). There were no admissions to intensive care unit and no deaths within 30 days of surgery. The rates of leaks and strictures were 0%, and of hemorrhage 1.6%. At 12 months, BMI decreased to 24.7 ± 2, and the percentage of excess weight loss (% EWL) reached 76.5%. None of the patients had a BMI below 20 kg/m². Comorbidities resolved in 70.5% or improved in 29.5%. Patient satisfaction scoring (1-5) at least 1 year after was 4.6 ± 0.8 for body image and 4.4 ± 0.6 for food tolerance. CONCLUSION: LSG for mildly obese patients has proved to be technically relatively easy, safe, and benefic in the short term.

Multiple biliary hamartomas: magnetic resonance features with histopathologic correlation.

The purpose of this study was to report the magnetic resonance imaging (MRI) features of multiple biliary hamartoma (MBH) and to correlate them with histopathology. MRI features of 11 patients with MBH proven by histology were retrospectively reviewed and correlated to histopathology. MBH presented as multiple, tiny, and uniformly distributed lesions in all cases. All were hypointense on T1-weighted images and hyperintense on T2-weighted images relative to the liver parenchyma. Mural nodules were identified in 10 of 11 (91%) cases. They were isosignal on T1-weighted images, intermediate signal on T2-weighted images. Gadolinium-enhanced images showed mural nodule enhancement in 9 of 10 patients (90%) or a peripheral rim-like enhancement of the whole lesion in one case (9%). MBH were present in all liver specimens. In the six patients examined at MR cholangiography, the lesions lacked communication with the biliary tree. At histopathology, the mural nodule corresponded to an endocystic polypoid projection made of conjunctive septa. Three (27%) patients had associated focal nodular hyperplasia, and 1 (9%) had concomitant cholangiocarcinoma. MRI features allowed diagnosis of MBH with accuracy. Their recognition, especially the mural nodule, may help avoid misdiagnosis.

Extracystic biliary carcinoma associated with anomalous pancreaticobiliary junction and cysts.

Anomalous pancreaticobiliary junction with cystic dilatation of the biliary tract is usually associated with carcinoma arising from the cyst wall. We report an extracystic location of biliary carcinoma in the presence of anomalous pancreaticobiliary junction and cysts in a patient with obstruction of the origin of the left hepatic duct who underwent hepatobiliary resection. Cholangiocarcinoma was found to have arisen in a noncystic left hepatic duct, in conjunction with cystic dilatation involving both the cystic and common bile ducts. The present case supports a relationship between anomalous pancreaticobiliary junction and biliary carcinogenesis that may affect the extracystic biliary tree.