ABSTRACT
INTRODUCTION: Small bowel obstruction (SBO) due to internal herniation (IH) is a well-known complication of laparoscopic Roux-en-Y gastric bypass (LRYGBP). The objective of this study is to evaluate different types of non-absorbable sutures used for closure of the defects regarding the incidence of SBO due to IH/adhesions, adhesion formation in general, or reopening of the defects. METHODS: A single-center retrospective study was performed. Patients who underwent LRYGBP were divided in 3 groups: group A closure of the defects with monofilament Polypropylene suture (Prolene®), group B with braided polyester suture (Ethibond®), group C with barbed knotless Polybutester suture (V-Loc®). Descriptive statistics were performed regarding SBO due to IH/adhesions, adhesion formation, and reopening of closed defects. RESULTS: From 5145 patients, 224 patients underwent exploratory laparoscopy for suspicion of SBO. Mean time interval was 28.4 months. IH or intermittent IH was found in 1.94% in group A, 1.78% in group B, and 1.40% in group C. Obstruction due to adhesions was found in 0.70%, 0.36%, and 0.42% per group, respectively. Adhesions in general were observed in 1.47% in group A, 1.43% in group B, and 1.06% in group C. The incidence of reopening was higher in group A (2.24%) in comparison with group B (1.13%, P = 0.041) and group C (1.05%, P = 0.001). CONCLUSIONS: After descriptive analysis, these results can withhold no difference among the 3 non-absorbable sutures regarding incidence of SBO due to IH or SBO due to adhesions, yet tendency for higher reopening rates after closure with monofilament Polypropylene suture is observed.
Subject(s)
Gastric Bypass , Intestinal Obstruction , Laparoscopy , Obesity, Morbid , Humans , Gastric Bypass/adverse effects , Gastric Bypass/methods , Retrospective Studies , Obesity, Morbid/surgery , Polypropylenes , Postoperative Complications/epidemiology , Postoperative Complications/surgery , Postoperative Complications/etiology , Intestinal Obstruction/epidemiology , Intestinal Obstruction/etiology , Intestinal Obstruction/surgery , Tissue Adhesions/epidemiology , Tissue Adhesions/etiology , Tissue Adhesions/surgery , Hernia/complications , Laparoscopy/adverse effects , Laparoscopy/methods , Sutures/adverse effectsABSTRACT
BACKGROUND AND AIMS: Bowel obstruction due to internal hernia (IH) is a well-known late complication of a laparoscopic roux-en-y gastric bypass (LRYGBP). The objective of this study is to evaluate if closure of the mesenteric defect and Petersen's space will decrease the rate of internal hernias compared to only closure of the mesenteric defect. METHODS: A single-center retrospective descriptive study was performed. All patients with LRYGBP from 2011 till April 2017 were included. An antecolic technique was used with closure of the mesenteric defect with a non-absorbable running suture between 2011 and October 2013 (group A), and from November 2013, we added closure of the Petersen defect (group B). RESULTS: From a total of 3124 patients, 116 patients (3.71%) had an exploratory laparoscopy due to suspicion of bowel obstruction, but in only 67 (2.14%) patients, an IH was found. Preoperative CT predicted the diagnosis in only 73%. In group A, including 1586 patients, 53 (3.34%) were diagnosed with an internal hernia: 39 at Petersen's space and 14 at the mesenteric defect. The mean time interval was 24.2 months and the mean BMI 25.7 kg/m2. After routine closure of the Petersen defect in 1538 patients in group B, an internal hernia during laparoscopy was found in 14 (0.91%) patients after a mean period of 13.5 months: 11 at Petersen's space and 3 at the mesenteric defect. In two subgroups (C and D) with an equal follow-up time (24-42 m), the incidence of 1.15% (8/699) was halved in the closure group of both defects compared to the incidence of 2.58% (23/893) in the group with only closure of the mesenteric defect. CONCLUSIONS: After descriptive analysis, these results can provide strong recommendation of closure of the mesenteric defect and Petersen's space, as we notice a tendency to lower incidence of internal hernias.
Subject(s)
Gastric Bypass/adverse effects , Hernia, Abdominal , Laparoscopy/adverse effects , Mesentery , Postoperative Complications , Hernia, Abdominal/epidemiology , Hernia, Abdominal/etiology , Hernia, Abdominal/surgery , Humans , Intestinal Obstruction , Mesentery/abnormalities , Mesentery/surgery , Obesity, Morbid/surgery , Postoperative Complications/etiology , Postoperative Complications/surgery , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: The management of chronic abdominal pain after laparoscopic Roux-en-Y gastric bypass (LRYGP) is complex and challenging. Foreign body intestinal perforation including that caused by fish bones has previously been reported in the literature and if clinically unrecognized, can cause significant morbidity and mortality. Fish bone perforation as a cause of chronic abdominal pain after LRYGP has rarely been reported. SUMMARY: The unusual case of a 54year old female presenting with recurrent episodes of postprandial pain 2 years after LRYGP is reported. Previous radiological and endoscopic investigations did not reveal any abnormality and after the most recent clinical presentation, a laparoscopic exploration was performed. A protruding fish bone at the biliary-digestive junction was discovered intra-operatively and successfully extracted. Dense adhesions between the involved intestinal loops were lysed in an attempt to improve intestinal transit and subsequently relieve post-prandial pain. CONCLUSION: This case highlights the possibility of a missed fish bone perforation causing chronic postprandial abdominal pain and discomfort in a patient with a Roux-en-Y gastric bypass anatomy. Foreign body perforation is a rare cause of abdominal pain after gastric bypass that should be considered when evaluating chronic abdominal pain symptoms after LRYGP.
ABSTRACT
BACKGROUND: An important population of patients who undergo biliopancreatic diversion (BPD) are fertile women. A consensus is needed with regard to contraceptive therapy after BPD by evaluating the risks of pregnancy, the safety of oral contraception and the changes in fertility after this bariatric surgery. METHOD: From May 1997 until May 1998, 40 women who underwent a BPD were included in a prospective study evaluating the hormone status preoperatively and postoperatively after 2 and 7 days, 3 and 6 months and 1 year. An extensive questionnaire, with regard to fertility and obstetric history, was sent at least 2 years after inclusion. A literature search was performed to understand the complex physiology of hormone changes after excess weight loss, as well as absorption and metabolism of oral contraceptives. RESULTS: Our laboratory results are consistent with hormone changes found in the literature, which show that rising levels of serum sex-hormone-binding globulin, follicle stimulating hormone and luteinizing hormone and decreasing levels of testosterone and dehydroepiandrosterone sulphate result in an improved fertility status, regulated through complex interactions, in particular with the gonatotropin-releasing-hormone pulse generator. The questionnaire shows the use of different types of contraception. From the 9 patients who only used oral contraception, 2 patients developed an unforeseen pregnancy after BPD. Although miscarriages and neonatal complications were seen in other patients in our hospital, none of these problems were seen in our study. CONCLUSION: Pregnancy should be avoided for 12 to 18 months after BPD. Fertility increases after BPD. As oral contraception is most popular and less reliable, we strongly believe that large multi-centre, prospective, randomized studies are necessary to come to a consensus about the use of contraceptive therapy after BPD.
Subject(s)
Biliopancreatic Diversion/adverse effects , Contraception/statistics & numerical data , Contraceptive Agents/administration & dosage , Needs Assessment , Obesity, Morbid/surgery , Pregnancy Complications/prevention & control , Adolescent , Adult , Belgium , Biliopancreatic Diversion/methods , Body Mass Index , Consensus , Female , Fertility/physiology , Humans , Patient Education as Topic , Postoperative Care , Pregnancy , Preoperative Care , Prospective Studies , Risk Assessment , Sampling Studies , Time FactorsABSTRACT
BACKGROUND: Laparoscopic adjustable gastric banding is a safe and effective treatment method for morbid obesity. Injection port dislocation, tube perforation and access port infection are generally classified among the minor complications, although they can require a reoperation at the port-site or even at the level of the band which may have to be removed. We designed a technique to fix the port, that can avoid unnecessary complications. METHODS: The port is sutured onto a polyprophlene mesh, which is then cut into shape and attached to the rectus fascia in the left hypochondrium with a Tacker stapling device. From February 2000 to January 2001, 25 patients (BMI 35-60) were operated using this technique. RESULTS: No injection port dislocation, tube perforation or access port infection has been found in these patients. CONCLUSION: With the larger surface area by which the port is attached to the fascia, a stable position of the port is obtained and dislocation avoided. Multiple failed attempts at port access, with resulting risk of infection, are avoided. Due to port stability, risk of incidental tube perforation is reduced. Moreover, a considerable gain of time is obtained compared with the classical suturing of the port.