Tests of correlation between immediate postoperative gastroduodenal transit times and weight loss after laparoscopic sleeve gastrectomy.

BACKGROUND: Previous studies have shown accelerated gastric emptying after sleeve gastrectomy. This study aimed to determine whether a correlation exists between immediate postoperative gastroduodenal transit time and weight loss after laparoscopic sleeve gastrectomy (LSG). Specifically, correlation tests were conducted to determine whether more rapid transit after LSG correlated with increased weight loss. METHODS: Data were collected from an institutional review board-approved electronic registry. All LSGs were performed over a 40-Fr bougie, starting 5 to 7 cm proximal to the pylorus. Gastroduodenal transit time (antrum to duodenum) was calculated from a postoperative day 1 esophagram. Pearson's correlation coefficient was used for statistical analysis. RESULTS: The analysis included 62 consecutive LSG patients. The mean gastroduodenal transit time was 12.3 ± 19.8 s. Almost all the patients (99%) had a transit time less than 60 s. The mean percentage of excess weight loss (%EWL) was 23.8 ± 9.8% at 3 months, 37.9 ± 11.8% at 6 months, and 52.2 ± 10.8% at 12 months. No correlation was found between gastroduodenal transit time and %EWL at 3, 6, or 12 months. CONCLUSION: No correlation was found between gastroduodenal transit time and weight loss after LSG.

One Hole, Two Tubes, and a Tijuana Pathology Report: A Case Report of Cholecystoduodenal Fistula Mistaken for Gallbladder Cancer.

We report a case of a patient who presented with biliary colic while in Tijuana, Mexico. Laparoscopic cholecystectomy was attempted but abandoned and only a biopsy of the gallbladder was performed with pathologist reporting gallbladder adenocarcinoma. Upon return to the United States, extensive evaluation was undertaken including imaging, biopsy, and ultimately two separate exploratory surgeries revealing no neoplasm. Only at the second surgical exploration did we discover a benign cholecystoduodenal fistula successfully treated with completion fenestration cholecystectomy, pyloric exclusion, loop gastrojejunostomy, and duodenostomy tube through the gallbladder remnant into the fistula itself. This is a unique surgical treatment of a rare problem made even more confusing by an erroneous pathology report from another country.