Endoscopic management of gastric band erosions: a 7-year series of 14 patients.

BACKGROUND: Intragastric band migration is an unusual but major complication of gastric banding. We review our experience with endoscopic removal of eroded gastric bands. METHODS: We retrospectively evaluated the cases of 110 morbidly obese patients who underwent adjustable gastric banding between 2005 and 2012 to identify those who experienced band erosion. To remove the migrated band, we used an endoscopic approach with a Gastric Band Cutter. RESULTS: Band or tube erosion occurred in 14 patients (12.7%). The median time interval from the initial gastric band placement to the diagnosis of band erosion was 32 (range 18-52) months. Upper abdominal pain, port site infection, loss of restriction and weight regain were the most common symptoms. We used the Gastric Band Cutter to remove the band endoscopically. It was able to cut the band successfully in all but 1 patient, in whom twisting of the cutting wire required conversion from endoscopy to laparotomy. In 2 patients, the band, after being cut, was locked in the gastric wall and required laparotomic removal. In 1 patient, we performed surgery for intragastric penetration of the connecting tube broken close to the band. CONCLUSION: The Gastric Band Cutter was successful in dividing the band in all but 1 patient, although we could not always complete the procedure endoscopically. Endoscopic removal seems to be effective and safe for band erosion.

CONTEXTE: La migration intragastrique de l'anneau est une complication rare, mais majeure du cerclage gastrique. Nous faisons le point sur notre expérience du retrait endoscopique des anneaux gastriques érodés. MÉTHODES: Nous avons évalué de manière rétrospective le cas de 110 patients atteints d'obésité morbide qui ont subi un cerclage gastrique ajustable entre 2005 et 2012 afin de vérifier si les anneaux en place étaient érodés. Pour retirer les anneaux qui avaient migré, nous avons utilisé l'approche endoscopique et un dispositif pour sectionner l'anneau gastrique. RÉSULTATS: L'anneau ou le tube s'est érodé chez 14 patients (12,7 %). L'intervalle médian entre la pose initiale de l'anneau gastrique et le diagnostic d'érosion a été de 32 (entre 18 et 52) mois. La douleur abdominale haute, l'infection du port d'accès, la diminution de la restriction et la reprise de poids ont été les symptômes les plus fréquents. Nous avons utilisé un dispositif pour sectionner l'anneau gastrique afin de retirer l'anneau par voie endoscopique. Le dispositif a permis de sectionner l'anneau avec succès chez tous les patients sauf 1; dans ce dernier cas, une torsion du fil à sectionner a nécessité la conversion de l'endoscopie en une laparotomie. Chez 2 patients, une fois sectionné, l'anneau est resté emprisonné dans la paroi gastrique et a nécessité une extraction laparotomique. Chez 1 patient, nous avons effectué une intervention chirurgicale en raison de la pénétration intragastrique de la tubulure de raccord sectionnée à proximité de l'anneau. CONCLUSION: Le dispositif servant à sectionner l'anneau gastrique a bien fonctionné chez tous les patients sauf 1, même si les interventions n'ont pas toutes pu être entièrement réalisées par voie endoscopique. Le retrait endoscopique semble être une intervention efficace et sécuritaire dans les cas d'érosion de l'anneau.

Effect of preserving the hepatic vagal nerve during laparoscopic Nissen fundoplication on postoperative biliary functions.

BACKGROUND: Cutting the hepatic branch of the anterior vagus nerve (HB-AVn) technically facilitates the laparoscopic Nissen fundoplication. The aim of this study was to investigate the effects of preserving or sacrificing this branch on postoperative gallbladder functions. METHODS: The patients (n = 40) were prospectively randomized into two groups. The HB-AVn was preserved during the dissection of the lesser omentum in the first group. The nerve was cut in the second group. Postoperative fasting gallbladder volumes were calculated by ultrasonography. Postoperative gallbladder ejection fraction (GEF) and gallbladder emptying time (GET) were determined by calculating intestinal transit time scintigraphically. RESULTS: Fasting gallbladder volumes and GEF values were not different between the groups. On the other hand, in patients with HB-AVn preserved, GET measurements were found to be significantly shorter than those with HB-AVn sacrificed. CONCLUSIONS: Sacrificing the hepatic branch causes prolongation in the GET. This change in the motor functions of the gallbladder does not cause any symptomatic effect during the early postoperative period. However, the delay in the GET may increase the risk of gallbladder stone formation in the long term.

Increased nutritional risk in major trauma: correlation with complications and prolonged length of stay.

BACKGROUND: Acute Physiology and Chronic Health Evaluation II (APACHE II) and the Trauma Injury Severity Score (TRISS) are physiological and anatomical severity scores to predict trauma outcome. Nutritional Risk Screening (NRS-2002) is used for the screening of nutritional risk, which can affect outcome adversely. The objective of this study was to determine the reliability of these scales to predict disease severity, complications and mortality, and to compare the reliability of the NRS-2002 in predicting outcome with different scoring systems in trauma-intensive care unit (ICU) patients. METHODS: The study enrolled 100 consecutive patients who were admitted to the ICU in a training hospital due to trauma in the six-month study period (1 July 2008 and 1 January 2009). Discrimination characteristics of the scoring systems were evaluated using receiver operating characteristic (ROC) curves. RESULTS: Overall mortality was 14%, and the complication rate was 22%. Nutritional risk at admission was found to be increased in 58% of the patients. The NRS-2002 score was increased in patients with complication. ISS, TRISS and APACHE II at admission had a reliable power of discrimination (AUC>0.8) for mortality and complication prediction. The NRS-2002 score had moderate discrimination power for complication prediction (AUC=0.708) but showed high correlation with increased length of stay (LOS). CONCLUSION: A significant percent of trauma patients are at nutritional risk. The NRS-2002 score can be useful in predicting complication and prolonged LOS in trauma patients.

Acute pancreatitis, bacterial translocation, and different octreotide regimens: an experimental study.

PURPOSE: To determine the effect of octreotide, octreotide with zinc, levamisole, and misoprostol on the bacterial translocation that develops in rats with acute pancreatitis (AP). METHODS: A total of 36 rats were divided into six groups, each consisting of six rats. Only laparotomy was performed on the first group. Acute pancreatitis was performed on the second group. Octreotide was given to the third, fourth, fifth, and sixth groups. Octreotide, octreotide with zinc, levamisole, and misoprostol were given to groups III, IV, V, VI, respectively. Rats were euthanized 48 h after the occurrence of AP. Blood and mesenteric lymph node samples were collected for polymerase chain reaction (PCR). Pancreatic tissue and terminal ileum were obtained for histopathological examinations. RESULTS: The severity of pancreatitis and mucosal damage of the terminal ileum was higher in group II than groups I, III, IV, V, and VI, histopathologically (P < 0.05). There wasn't a significant difference with respect to OA with Zn or L or M and OA group (P > 0.05). A significant difference was found in PCR positivity in blood and mesenteric lymph node between groups I and II (P < 0.05). CONCLUSIONS: In AP, administering octreotide alone significantly prevented the bacterial translocation by preventing mucosal damage. The zinc, levamisole, or misoprostol with octreotide did not influence the results.

Gastroscopic removal of a migrated adjustable gastric band: a case report.

Laparoscopic gastric banding is a popular method for treating morbid obesity. Band migration is a well-known late complication and the treatment is usually reoperation. In this case report, we show that a band penetrating the gastric wall can be treated by gastroscopic operation with the Gastric Band Cutter device without complication. It seems that this technique is simpler than reoperation and is beneficial even when the intraluminal migration is partial.