An unusual case of early small bowel obstruction after Roux-en-Y gastric bypass by the free end of a V-loc™ suture.

Weight recurrence and gastro-esophageal reflux disease are the most common causes for re-operation after sleeve gastrectomy (SG); Roux-en-Y gastric bypass is the recommended procedure to correct both problems. The V-loc™ (Covidien, Dublin, Ireland) enables faster suturing and less operative time compared to non-barbed sutures. We report an unusual case of early obstruction at the jejunojejunostomy by the tail of V-loc™ suture which grasped surrounding tissue causing adhesions and subsequent obstruction. When reviewing the literature for complications of V-loc™, we found three cases of bowel obstruction caused by the leftover free segment of V-loc™. So, V-loc™ thread can cause small bowel obstruction; therefore, we recommend not leaving an extra length at its free end and keep it to a minimum length possible.

Effect of Bariatric Surgery on Albuminuria in Non-Diabetic Non-Hypertensive Patients with Severe Obesity: a Short-Term Outcome.

BACKGROUND: Obesity is a risk factor for chronic kidney disease and albuminuria. Despite the well-documented obesity association with diabetes mellitus and hypertension, its predisposition to albuminuria is not related to these comorbidities, and, in some times, its occurrence is independent of DM or hypertension. PURPOSE OF THE STUDY: The present study aimed to evaluate bariatric surgery effect on albuminuria in patients with severe obesity with no DM or hypertension. MATERIALS AND METHODS: The study consisted of 137 patients with extreme obesity and albuminuria scheduled for bariatric surgery and did not have diabetes or hypertension. They underwent an assessment for 24-h urinary albumin at baseline (T0) and 6 months postoperatively (T2). RESULTS: Albuminuria remission occurred in 83% of patients; there was a statistically highly significant difference between the baseline and the 6-month postoperative in the 24-h urinary albumin assessment. Weight loss and BMI at T2 were independent predictors of albuminuria remission. CONCLUSION: The current work emphasizes the importance and promising role of bariatric surgery as an effective weight reduction management method in improving albuminuria, an early sign of chronic kidney disease, and a potential risk factor for cardiovascular disease.

Secondary Hyperparathyroidism Before and After Bariatric Surgery: a Prospective Study with 2-Year Follow-Up.

PURPOSE: Secondary hyperparathyroidism (SHPT) is linked to obesity. Bariatric surgery may be associated with calcium and vitamin D deficiencies leading to SHPT. This study aimed to detect the prevalence of SHPT before and after bariatric surgery. METHODS: This prospective study assessed the prevalence of SHPT after sleeve gastrectomy (SG, n = 38) compared to one-anastomosis gastric bypass (OAGB, n = 86). All patients were followed up for 2 years. Bone mineral density (BMD) was assessed using dual-energy X-ray absorptiometry. RESULTS: Of the 124 patients, 71 (57.3%) were females, and 53 (42.7%) were males, with a mean age of 37.5 ± 8.8 years. Before surgery, 23 patients (18.5%) suffered from SHPT, and 40 (32.3%) had vitamin D deficiency. The prevalence of SHPT increased to 29.8% after 1 year and 36.3% after 2 years. SHPT was associated with lower levels of vitamin D and calcium and higher reduction of BMD in the hip but not in the spine. After 2 years, SHPT was associated with a significantly lower T-score in the hip. SHPT and vitamin D deficiency were significantly more common in patients subjected to OAGB compared to SG (p = 0.003, and p < 0.001, respectively). There is a strong negative correlation between vitamin D levels and parathormone levels before and after surgery. CONCLUSION: Prevalence of SHPT is high in obese patients seeking bariatric surgery, especially with lower vitamin D levels. Bariatric surgery increases the prevalence of SHPT up to 2 years. Gastric bypass is associated with a higher risk of developing SHPT compared to SG.

Combined Thoracic Spinal-Epidural Anesthesia for Laparoscopic Sleeve Gastrectomy; One Hundred Case Experience.

BACKGROUND: Obesity is a growingly impacting human health concern. Laparoscopic sleeve gastrectomy (LSG) is an effective treatment for morbid obesity. However, the general anesthesia (GA) used in this major surgery has its documented drawbacks in obese patients with high risk. On the other hand, combined thoracic spinal-epidural anesthesia (CTSEA), a modern regional anesthesia procedure, has the advantages of both spinal and epidural anesthesia but without their shortcomings. This prospective study is a case experience that assesses the feasibility of CTSEA as an anesthesia option for laparoscopic sleeve gastrectomy (LSG). METHODS: A total of 100 patients were recruited for LSG as a management procedure for morbid obesity, which was performed under CTSEA. Perioperative events, functional parameters, and patients' satisfaction scores were recorded. RESULTS: Our prospective study showed successful use of CTSEA in 99% of the patients, except for one patient (1%) in whom CTSEA was converted into GA due to severe pain and anxiety. Few adverse events occurred and were managed accordingly. The satisfaction score revealed that 94% of the patients were satisfied. CONCLUSIONS: CTSEA was a successful anesthetic alternative procedure for LSG surgery.

Laparoscopic Roux-en-Y Gastric Bypass After Failed Vertical Banded Gastroplasty: 2-Year Follow-up of 102 Patients.

BACKGROUND: Vertical banded gastroplasty (VBG) is now discarded from being a restrictive procedure for morbid obesity due to its many drawbacks, doubtful efficacy, and lots of post-operative complications. Roux-en-Y gastric bypass (RYGB) is the most commonly performed procedure for VBG revision. So we aimed at reporting our experience in conversional RYGB for a failed VBG. MATERIAL AND METHODS: Analyzing follow-up records of 102 patients who underwent revisional RYGB after failed VBG in the period from April 2014 to January 2018. RESULTS: A total of 102 laparoscopic revisions of failed VBGs to RYGB were performed. The mean operating time was 161.9 min ±29.2 and the mean length of the hospital stay was 1.5 days ±1.2. Fourteen patients (13%) developed early post-operative complications (gastrojejunostomy leak 5; bleeding 9). Four patients (4.7%) developed late complications (Port site hernia 2; internal hernia 1; Stomal ulcer 1). The mean BMI pre-RYGB was 46.6 ± 5.9 kg/m2, and the mean %EBWL (percent excess body weight lost) of the patients at 12 and 24 months post-revision were 56.2% and 64.3%, respectively. Our patients had immediate post-revision resolution of VBG-related complications like dysphagia and vomiting. We also report improvement in all obesity-related health problems with (75.7%) complete remission rate and (24.3%) partial remission or improvement rate of diabetes mellitus. CONCLUSION: Conversion of VBG to RYGB is a feasible procedure and is associated with acceptable early morbidity rates and reduced lengths of hospitalization also it provides acceptable weight loss and improvement in obesity-related health problems. Graphical Abstract.