Esophageal perforation during laparoscopic adjustable gastric band: conversion to open sleeve gastrectomy and endoscopic stent placement.

Laparoscopic adjustable gastric band (LAGB) is one of the most popular bariatric surgical procedures both in Europe and United States, because it is considered to be a safe and effective way of treating morbid obesity. This minimally invasive frequently employed bariatric procedure has many reported complications, but only a few cases of esophageal perforation have been reported. We present a case of iatrogenic esophageal perforation in an 18-year-old patient occurring during attempt to place an adjustable gastric band laparoscopically, which was diagnosed intraoperatively. Conversion to open sleeve gastrectomy with primary suturing of the perforation and drainage were performed. On the early postoperative period leak from the intra-abdominal part of the esophagus was diagnosed and treated with endoscopic placement of a self-expandable metal stent. After 2-years of follow-up the patient continues to have no sequelae from the perforation or symptoms of dysphagia, while Excess Weight Loss is 74.

Gastrointestinal complications after vertical banded gastroplasty.

BACKGROUND: Gastric surgical procedures for morbid obesity may have occasional serious complications. The vertical banded gastroplasty according to Mason's technique (VBG) is a common procedure for morbid obesity. The aim of this study is to present the complications in the gastrointestinal (GI) tract after VBG and to discuss their treatment. METHODS: In this study 260 morbidly obese patients (62 males and 198 females) underwent VBG. RESULTS: Complications in the GI tract were encountered as follows: narrowing of the communicating lumen of the two parts of the stomach in four patients, dehiscence of the vertical stomach staple line in three patients, cholelithiasis in 12 patients, gastric perforation in four patients, postoperative fistulas in three patients, serious hepatic failure in one patient, significant gastritis and esophagitis in 32 patients, intestinal obstruction in five patients and frequent prolonged vomiting in 23 patients. The authors attempted to treat all these complications conservatively. In 22 patients, however, a new procedure was necessary. In some cases a partial gastrectomy was necessary. CONCLUSION: VBG is considered to be a satisfactory procedure for weight loss in morbid obesity, but has occasional complications from the GI tract, besides the complications from the other systems. Thus, this procedure should be performed only when absolute indications exist.

The effect of methylprednisolone on the sodium and water content of the dog lung after hemorrhagic shock.

Out of 17 mongrel dogs, 3 were subjected on one and two hours of hemorrhagic shock, while the remaining four served as controls. In five of the thirteen dogs, 30 mg/kg of methylprednisolone sodium succinate were administered intravenously one hour after hemorrhage. All animals were sacrificed at the end of the experiment, their lungs were removed and the sodium and water content was measured. The sodium content was found to be markedly increased at the end of two hours of hemorrhagic shock. This increase was prevented significantly by the administration of pharmacological doses of methylprednisolone given at one hour of hemorrhagic shock. No significant change in total lung water was noted, even after two hours of hemorrhagic shock. The results of this study suggest that early intravenous administration of large doses of methylprednisolone may be beneficial to patients in protracted hemorrhagic shock, who are at high risk of developing pulmonary complications.

Spontaneous rupture of splenic artery aneurysm in pregnancy: a case report.

Splenic artery aneurysms (SAA) occur predominantly in women, and the majority of them are asymptomatic until rupture. Over half of those that rupture occur during pregnancy. Spontaneously ruptured SAA during pregnancy is always a life-threatening surgical entity for both the mother and the fetus. We report the case of a 29-year-old woman at 34 weeks' gestation with spontaneous rupture of SAA who underwent emergency exploratory laparotomy and splenectomy. This case illustrates the need to consider ruptured SAA as part of important differential diagnosis in haemodynamically unstable pregnant women.

Simultaneous liver-renal grafting for polycystic disease.

Our purpose was to describe the first in our country and fourth worldwide simultaneous liver and renal grafting for polycystic disease.