Laparoscopic spleen-preserving distal pancreatectomy in a solitary true pancreatic cyst.

BACKGROUND: Solitary true pancreatic cysts (STPCs), or epithelial cysts, are benign lesions that are extremely rare in adult patients. Advances in radiographic techniques have improved the ability to identify pancreatic cystic lesions. We report a case of a large and symptomatic STPC in a 47-year-old female patient who was treated successfully with spleen-preserving laparoscopic distal pancreatectomy. We also review the clinical and pathologic features of all reported STPCs within the past 25 years. DATABASE: To compose the review, we did a search of the international literature for STPCs that had occurred in adults. Fourteen related articles were found describing cases of STPCs. Clinical and pathologic information was collected for all of the reported pancreatic cysts, and a database was formed. STPCs are detected more frequently in women than in men. The mean age of occurrence is 43.2 years, and the mean cyst size is 5.6 cm. Fifty percent of true cysts are located in the head of the pancreas. Size and site are responsible for the symptoms caused, although 22.8% were asymptomatic. Diagnosis was made postoperatively in all cases by histopathologic studies. No case of malignancy was reported in any STPC. CONCLUSIONS: STPCs are rare and benign lesions commonly discovered incidentally during abdominal imaging. Surgical treatment is considered the appropriate therapy for large and symptomatic STPCs. The definitive diagnosis is established by histopathologic and immunohistochemical studies.

Neuroendocrine tumors of extrahepatic biliary tract.

Neuroendocrine tumors of the extrahepatic bile ducts (EBNETs) are very rare. The aim of the present review is to elucidate the characteristics of EBNETs, their treatment and prognosis. An exhaustive systematic review of the literature was performed from 1959 up-to-date. One hundred articles, describing 150 cases were collected. Each article was carefully analyzed and a database was created. The most common symptoms were jaundice (60.3 %) and pruritus (19.2 %). Cholelithiasis co-existed in 15 cases (19.2 %). Hormone- and vasoactive peptide- related symptoms were present in only 7 cases (9 %). The most frequent sites were found to be the common hepatic duct and the proximal common bile duct (19.2 %). Surgical management was considered the main treatment for EBNETs, while excision of extrahepatic biliary tree (62.82 %) with portal vein lymphadenectomy (43.6 %) was the most popular procedure. EBNETs are extremely rare. Their rarity makes their characterization particularly difficult. Up to date the final diagnosis is made after surgery by pathology and immunohistochemistry findings. The present analysis of the existing published cases elucidates many aspects of these tumours, giving complete clinicopathological documentation.

Small bowel perforation due to CMV enteritis infection in an HIV-positive patient.

BACKGROUND: Cytomegalovirus infection of the gastrointestinal tract is common and is more often seen in patients with acquired immunodeficiency syndrome (AIDS). Although small bowel infection is less common than infection of other parts of the gastrointestinal system, it may lead to perforation, an acute complication, with dreadful results. CASE PRESENTATION: This article reports a case of Cytomegalovirus ileitis with multiple small bowel perforations in a young man with human immunodeficiency virus (HIV) infection. The patient developed abdominal pain with diarrhea and fever, and eventually acute abdomen with pneumoperitoneum. The patient had poor prognosis and deceased despite the prompt surgical intervention and the antiviral therapy he received. At pathology a remarkable finding was the presence of viral inclusions in smooth muscle fibers. The destruction of muscle cells was the main cause of perforation. CONCLUSION: Morbidity and mortality associated with perforation from CMV enteritis in AIDS patients are high and the life expectancy is short. Cytomegalovirus disease is multifocal; therefore, excision of one portion of the gastrointestinal tract may be followed by a complication elsewhere. Our case elucidate that muscle cell destruction by the virus is a significant cause leading to perforation.

Necrotizing cellulitis of the abdominal wall, caused by Pediococcus sp., due to rupture of a retroperitoneal stromal cell tumor.

INTRODUCTION: Soft tissue necrotizing infections are a significant cause of morbidity and mortality. The aim of this study is to present a patient with necrotizing infection of abdominal wall resulting from the rupture of a retroperitoneal stromal tumor. PRESENTATION OF CASE: We present a 60-year-old Caucasian male patient with necrotizing infection of abdominal wall secondary to the rupture of a retroperitoneal stromal tumor. The patient was initially treated with debridement and fasciotomy of the anterior abdominal wall. Laparotomy revealed purulent peritonitis caused by infiltration and rupture of the splenic flexure by the tumor. Despite prompt intervention the patient died 19 days later. The isolated microorganism causing the infection was the rarely identified as cause of infections in humans Pediococcus sp., a gram-positive, catalase-negative coccus. DISCUSSION: Necrotizing infections of abdominal wall are usually secondary either to perineal or to intra-abdominal infections. Gastrointestinal stromal cell tumors could be rarely complicated with perforation and abscess formation. In our case, the infiltrated by the extra-gastrointestinal stromal cell tumor ruptured colon was the source of the infection. The pediococci are rarely isolated as the cause of severe septicemia. CONCLUSION: Ruptured retroperitoneal stromal cell tumors are extremely rare cause of necrotizing fasciitis, and before this case, Pediococcus sp. has never been isolated as the responsible agent.

Rupture of right hepatic duct into hydatid cyst.

Echinococcal disease can develop anywhere in the human body. The liver represents its most frequent location. Hepatic hydatid cysts may rupture into the biliary tract, thorax, peritoneum, viscera, digestive tract or skin. We report a rare case with rupture of the right hepatic duct into a hydatid cyst in a woman with known hydatid disease and choledocholithiasis. The increased intra-luminal pressure in the biliary tree caused the rupture into the adjacent hydatid cyst. The creation of the fistula between the right hepatic duct and the hydatid cyst decompressed the biliary tree, decreased the bilirubin levels and offered a temporary resolution of the obstructive jaundice. Rupture of a hydatid cyst into the biliary tree usually leads to biliary colic, cholangitis and jaundice. However, in case of obstructive jaundice due to choledocholithiasis, it is possible that the cyst may rupture by other way around while offering the patient a temporary relief from his symptoms.

The effects of chronically increased intra-abdominal pressure on the rabbit diaphragm.

BACKGROUND: Diaphragmatic muscular remodeling is caused by various conditions and was mainly studied in pulmonary pathologies and chronic alterations of intra-thoracic pressure. We investigate the effect of the chronically increased intra-abdominal pressure (IAP) on the diaphragm by morphological and biochemical analysis. METHODS: Thirty rabbits were divided into control and study groups. IAP was increased in group B to 12 mmHg for 2 months. The left hemidiaphragm underwent morphological, while the right underwent biochemical analysis. RESULTS: In H&E, all fibers were normal. ATPase analysis demonstrated that type I fibers show no differences between groups. Type ΙΙ(Α) were decreased (p = 0.016) while type ΙΙ(Β/X) fibers were increased (p = 0.025) in group B. Fibers with resistance to fatigue were decreased in group B (p = 0.024). In group B, biochemical activity for glutathione reductase (p = 0.004), glutathione peroxidase (p = 0.021), protein carbonylation (0.029), lipid peroxidation (p = 0.005), and balance of preoxidative-antioxidative factors (p = 0.006) was increased. CONCLUSIONS: Chronically increased IAP induces alterations to the rabbit diaphragm. Adaptation, equivalent to strenuous contraction, transforms the diaphragm to be functionally more efficient toward workload but makes it vulnerable against oxidative stress.

Intraoperative stimulation neuromonitoring versus intraoperative continuous electromyographic neuromonitoring in total thyroidectomy: identifying laryngeal complications.

BACKGROUND: Laryngeal complications occur in thyroidectomies as a result of several factors, but especially because of nerve damage. We compared intraoperative stimulation neuromonitoring (IONM) with intraoperative continuous electromyographic neuromonitoring (IEM) to evaluate their ability to identify postoperative laryngeal complications. METHODS: This prospective clinical trial included 174 patients (348 nerves) who had both IONM and IEM. We recorded age, sex, pathology, vocal fold motility, and complications. RESULTS: IONM identified 334 nerves, whereas IEM identified 348. Five patients had transient laryngeal complications, 2 bilateral, and 3 unilateral recurrent laryngeal nerve paresis. In addition, in 2 patients IEM showed placement of the tracheal tube balloon on the vocal folds, which led to correction. Sensitivity and specificity were 96.48% and 100% for IONM and 100% and 100% for IEM, respectively. IONM had a positive predictive value of 100% and a negative predictive value of 36.84%. The positive and negative predictive values of IEM were 100%. CONCLUSIONS: Both techniques identify recurrent laryngeal nerve injuries; however, IEM seems to have an advantage concerning the nonsurgical laryngeal complications and may play a role in preventing morbidity.

Abdominal compliance, linearity between abdominal pressure and ascitic fluid volume.

BACKGROUND: Drainage of ascitic fluid is a common practice in order to relief the respiratory discomfort of patients. AIM: To determine the relation between the intra-abdominal pressure (IAP) and extracted volume of the ascitic fluid, in order to calculate abdominal compliance (Cabd). SETTINGS AND DESIGN: A study was designed at AHEPA University Hospital and analysed with prospectively collected data. MATERIALS AND METHODS: Fifteen patients with tension ascites that had transcutaneous drainage with a wide catheter. The ascitic fluid removed was measured, while the IAP and a Visual Analogue Scale (VAS) score for dyspnea were recorded before and 15 min after the puncture. Cabd was calculated. STATISTICAL ANALYSIS: The data were analysed with descriptive statistics, paired Student's t-test and Pearson coefficiency. RESULTS: The predrainage IAP was 18.26 mmHg (SD 1.67 mmHg), while the postdrainage was 14.46 mmHg (SD 1.34 mmHg) (P<0.001). The mean volume of ascitic fluid removed was 1624 mL (SD 861 mL). Cabd after drainage was 414.01 mL/mmHg (SD 139.15 mL/mmHg). A linear correlation was found between ascitic fluid removal and IAP variations. The dyspnea VAS score was 7.5 (SD=0.8) before the drainage and 4.3 (SD=1.0) after the drainage (P<0.001). CONCLUSIONS: The drainage of ascitic fluid reduces IAP, facilitating in this way respiration. Moreover, IAP variation seems to be in linear relation with the volume of ascitic fluid removed. This linear relation between IAP and volume may probably predict the Cabd quite accurately and vice versa. However, larger studies are necessary to safely draw predicting ΔIAP - ΔV (Cabd) diagrams, and determine the optimal ascitic fluid removal to achieve best comforting of the patient and slower fluid reformation.

Cervical thymic cysts in adults.

BACKGROUND: Three types of cervical thymic anomalies have been described: ectopia, thymic cyst, and thymoma. Thymic cysts are very rare causes of benign neck masses in adults and are usually not diagnosed before surgery. Their prevalence is less than 1% of all cervical masses, and they are usually noted in childhood. We systematically reviewed the literature concerning cervical thymic cysts (CTCs) in adults. SUMMARY: We identified 36 adult patients with a CTC. Our analysis included age, gender, cyst size, location, type, symptoms, time from cyst appearance, treatment, pathology, and follow-up. The male/female ratio was 4/5, the mean age was 36 years. Most of the cysts were asymptomatic masses diagnosed by pathology. In only one case did the differential diagnosis include a thymic cyst. Surgery should be considered the treatment of choice, but the size and location of the lesion and its relationship to nearby vital structures should be defined as clearly as possible preoperatively. Excision can be made via a transverse cervical incision. It may be a demanding procedure because of the close anatomical relationship of the CTCs with the carotid sheath and major nerves of the neck (recurrent laryngeal nerve, glossopharyngeal nerve, hypoglossic nerve, and phrenic nerve), particularly if there is adherence of the CTC with those structures. CONCLUSIONS: CTCs are uncommon lesions causing neck swelling and are often misdiagnosed preoperatively. Surgical excision and histological examination of the specimen usually makes the diagnosis. The existence of normal thymus gland in the mediastinum should be confirmed intraoperatively, but this is not critical in adult patients. A CTC should be included in the differential diagnosis of cervical cystic masses.

Diaphragmatic adaptation following intra-abdominal weight changing.

BACKGROUND: The diaphragm, the major respiratory muscle, contains three types of muscular fibers in dynamic balance between them. The fiber ratios vary in time in function of conditions, such as aging, hypoproteinemia, exercise, and chronic respiratory load. The diaphragmatic adaptation following abdominal conditions remains an unexplored field. This experimental study aims to identify the changes of the diaphragm due to chronic abdominal weight load. This may find application in conditions such as pregnancy, ascites, visceromegaly, large masses, and morbid obesity. METHODS: Thirty rabbits were divided into control (A) and study (B) groups. Group B was loaded with weight for 2 months. The left costal hemidiaphragm were stained with H&E and ATPase (fiber typing), while the right underwent biochemical analysis (prooxidative-antioxidative balance, lipid peroxidation, superoxide dismutase, glutathione reductase and peroxidase activities, total glutathione, and protein carbonylation). RESULTS: In H&E, all fibers were within normal range. ATPase analysis demonstrated reduction of type I (p = 0.019) and an increase of the type ΙΙ(Α) fibers ratio (p < 0.001) in group B, while the type ΙΙ(Β/X) fibers ratio remained stable. The above suggest remodeling of type I fibers into type II(A). Concerning biochemical analysis, difference was observed in glutathione peroxidase activity (p < 0.001). CONCLUSIONS: Chronically loaded abdomen leads to morphological adaptations of the costal diaphragm, but with minor oxidative stress. These diaphragmatic morphological changes are equivalent to heart failure or severe COPD, showing that this remodeling makes the muscle more efficient towards work load, but more vulnerable to fatigue.

The effect of chronically increased intra-abdominal pressure on rectus abdominis muscle histology an experimental study on rabbits.

BACKGROUND: The aim of this study was to specify the histologic response of the rectus abdominis muscle of the rabbit, to the chronically increased intra-abdominal pressure. MATERIALS AND METHODS: Forty-five New Zealand white rabbits were divided into three groups. In all groups, a rubber bag was implanted into the peritoneal cavity. In group A (n=15) the bags were kept empty. In group B (n=15) the bags were filled with normal saline in order to achieve an intra-abdominal pressure of over 12 mmHg. This pressure was kept at this level for 8 wk. In group C (n=15) the intra-abdominal rubber bags were filled with lead covered by silicone, equiponderant to the mean weight of the normal saline insufflated in group B. After 8 wk we took biopsies of the rectus abdominis muscle and counted the proportion of the different types of muscular fibers (type I, IIA, and IIB/X). RESULTS: Significant difference was found in the proportion of the three types of muscle fibers. Intra-abdominal hypertension led to an increase in type I fibers (P=0.008). No difference was noticed between groups A and C. CONCLUSIONS: The histologic response to the increased intra-abdominal pressure was an increase in type I muscle fibers. Charging with lead did not cause any significant change in the proportion of muscular fibers.

Umbilical endosalpingiosis: a case report.

INTRODUCTION: Endosalpingiosis describes the ectopic growth of Fallopian tube epithelium. Pathology confirms the presence of a tube-like epithelium containing three types of cells: ciliated, columnar cells; non-ciliated, columnar secretory mucous cells; and intercalary cells.We report the case of a woman with umbilical endosalpingiosis and examine the nature and characteristics of cutaneous endosalpingiosis by reviewing and combining the other four cases existing in the international literature. CASE PRESENTATION: A 50-year-old Caucasian, Greek woman presented with a pale brown nodule in her umbilicus. The nodule was asymptomatic, with no cyclical discomfort or variation in size. Her personal medical, surgical and gynecologic history was uneventful. An excision within healthy margins was performed under local anesthesia. A cystic formation measuring 2.7×1.7×1 cm was removed. Histological examination confirmed umbilical endosalpingiosis. CONCLUSIONS: Umbilical endosalpingiosis is a very rare manifestation of the non-neoplasmatic disorders of the Müllerian system. It appears with cyclic symptoms of pain and swelling of the umbilicus, but not always. The disease is diagnosed using pathologic findings and surgical excision is the definitive treatment.

Management of an extrasphincteric fistula in an HIV-positive patient by using fibrin glue: a case report with tips and tricks.

BACKGROUND: Individuals with impaired immunity are at higher risk of perianal diseases. Concerning complex anal fistulas impaired healing and complication rates are also higher. Definitive treatment of a fistula aims controlling the purulent discharge and prevents its recurrence. It depends mainly on the trajectory of the fistula and the underlying disease. We present a case of a HIV-positive patient with a complex extrasphincteric anal fistula who was treated successfully with fibrin glue application. We further, discuss tips and tricks when applying fibrin glue as plugging material in complex anal fistulas. CASE PRESENTATION: A sixty-one-year-old HIV-positive male referred to us for warts and extrasphincteric fistula. Because of the patients' immunological status, we opted against surgery and recommended fibrin glue plugging. The patient was discharged the same day. A follow-up examination was performed 5 days after the initial fibrin glue application showing that the fistula canal was obstructed. Three months and a year post-intervention the fistula tract remains closed. CONCLUSION: The best treatment for a disease gives at least the same result with the other treatments with minimised risk for the life of the patient and minimal application effort. Conservative closure of fistula with fibrin plugging is simple, safe and with less morbidity than surgery. Our patient was successfully treated without endangering his life despite his precarious medical state. Not everybody believes in the effectiveness of fibrin glue application, however we consider this solution in cases of complex fistulas at least as primary procedure in special populations such as the immunosupressed.

Minimally invasive video-assisted total thyroidectomy: an easy to learn technique for skillful surgeons.

BACKGROUND: Minimally invasive video-assisted total thyroidectomy (MIVATT) is a treating option for small thyroids that demands skills required for both traditional thyroidectomy and endoscopic surgery. This prospective study aims to define the learning curve for MIVATT for residents, with experience in traditional thyroid and laparoscopic surgery. METHODS: In all, 36 MIVATTs for benign disease were evenly divided among 4 residents. We recorded and analyzed: age, sex, pathology, thyroid weight, duration of the operation, ΔCa (postoperative minus preoperative calcemia), ΔWBC (postoperative minus preoperative white blood cell count), vocal motility, operative difficulty, postoperative vocal alteration, postoperative pain, complications, gram of gland excised per minute of the operation, conversion, and hospitalization. RESULTS: Statistically significant differences were observed in the different learning points, between duration of surgery (p < .001), operative difficulty (p = .022), grams of gland excised per minute of operation (p < .001), and WBC (p = .011). CONCLUSIONS: Surgeons that are experience in both thyroid and endoscopic surgery are subjects to a short learning curve concerning MIVATT.

Superficial selective cervical plexus block following total thyroidectomy: a randomized trial.

BACKGROUND: Pain after thyroid surgery is of moderate intensity and short duration. Bilaterally superficial cervical plexus block (BSCPB) may reduce analgesic requirements. However, its effectiveness in decreasing pain after thyroidectomy is debated. METHODS: This double-blind, randomized placebo-controlled study in 100 patients undergoing total thyroidectomy evaluates the effects of BSCPB done with 20 mL of 0.75% ropivacaine. Additional parecoxib was administrated immediately postoperatively and 12 hours later. RESULTS: Postoperative pain was assessed by visual analogue rating scale. All parameters were recorded at 0, 3, 6, 9, 12, and 24 hours after surgery. The control group had higher values than the ropivacaine group at all moments (p < .05) except H12 (p = .76). Additional analgesia was needed for 7 patients (14%) in the control group and for 8 patients (16%) in the group with ropivacaine (p = .96). CONCLUSION: Two-point bilateral BSCPB has a major analgesic effect on patients after total thyroidectomy, with a statistically significant reduction in postoperative pain scores. However, no significant difference was noted in the proportion of patients that required additional analgesics.

UltraCision harmonic scalpel versus clamp-and-tie total thyroidectomy: a clinical trial.

BACKGROUND: Hemostasis is important in thyroid surgery to avoid complications. Our aim was to evaluate the effectiveness of the harmonic scalpel in patients undergoing total thyroidectomy. METHODS: In this study, 90 patients were randomized into group A (classic technique of tying and knots) and group B (harmonic scalpel). We recorded the following: age, sex, pathology, thyroid weight, hemostatic technique, duration of operation, change in calcemia (DeltaCa), change in hematocrit (DeltaHt), change in hemoglobin (DeltaHgb), change in white blood cell count (DeltaWBC), vocal motility, operative difficulty, postoperative vocal alteration, postoperative pain, complications, blood in the drains, operating time, mass of gland excised per minute, and hospitalization. RESULTS: Differences (p < .05) were observed concerning duration of surgery, operative difficulty, postoperative pain, hospitalization, DeltaWBC, and quantity of gland removed per minute. No recurrent laryngeal nerve (RLN) palsies were observed. CONCLUSIONS: Use of the Harmonic Scalpel in total thyroidectomy is more effective than the clamp-and-tie technique: the duration of surgery, intraoperative difficulty, postoperative pain, and hospitalization are reduced. Both techniques are equivalent concerning RLN injuries, postoperative vocal alterations, and blood loss.

Retroperitoneal ganglioneuroma in an adult patient: a case report and literature review of the last decade.

Ganglioneuromas arise from the neural crest and are highly differentiated and benign. The case of a 43-year-old female who presented with a 6.5 cm primary extra-adrenal retroperitoneal ganglioneuroma (RGN) is presented, and the relevant English literature from the last decade is reviewed. Histology showed mature ganglion cells and nerve fibers without any malignancy (S-100 and neuron- specific enolase [NSE] positive). Hospitalization lasted four days. The patient has shown no signs of recurrence. Radical excision of the tumor is unnecessary, especially when vascular structures are endangered. RGN-related hospitalization is short and the prognosis is good.

Endoscopic fibrin sealing of gastrocutaneous fistulas after sleeve gastrectomy and biliopancreatic diversion with duodenal switch.

BACKGROUND AND AIM: Gastrocutaneous fistulas (GCF) are uncommon complications accounting for 0.5-3.9% of gastric operations. When their management is not effective, the mortality rate is high. This study reports the conservative treatment of GCF in morbidly obese patients who underwent biliopancreatic diversion with duodenal switch. METHODS: Ninety-six morbidly obese patients were treated in our department with biliopancreatic diversion with duodenal switch (Marceau technique) and, in six of them, a high-output GCF developed. A general protocol was applied to all patients presenting a GCF. Everyone was treated by total parenteral nutrition (TPN) and somatostatin for at least 7 days after the appearance of the leak. If the leak continued, then fibrin glue was used as a tissue adhesive. Endoscopic application of the sealant was accomplished under direct vision via a double-lumen catheter passed through a forward-viewing gastroscope. RESULTS: All patients were treated successfully with conservative treatment (either solely with TPN and somatostatin, or with endoscopic fibrin sealing sessions). No evidence of fistula was observed at gastroscopy 3 and 24 months after therapy. CONCLUSION: The conservative treatment of GCF following biliopancreatic diversion with duodenal switch is highly effective. All patients should enter a protocol that includes TPN and somatostatin. When the GCF persist, endoscopic sealing glue should be considered before operation because it is simple, safe, effective and, in some cases, life-saving. Therefore, conservative treatment should be employed as a therapeutic option in GCF developing after bariatric surgery.

Serum ghrelin, leptin and adiponectin levels before and after weight loss: comparison of three methods of treatment--a prospective study.

BACKGROUND: Ghrelin is a peptide hormone with orexigenic properties, primarily produced by the stomach. Leptin and adiponectin are the two adiposity products that participate in body weight control. Leptin always decreases and adiponectin increases after weight loss. Different changes in fasting ghrelin levels have been reported following bariatric surgery. In this study, we compare the changes in fasting ghrelin, leptin and adiponectin levels in 3 groups of patients who achieved weight loss by either diet, MacLean vertical banded gastroplasty (VBG) or biliopancreatic diversion with duodenal switch (BPD-DS). METHODS: Serum fasting ghrelin, leptin and adiponectin concentration was measured in 40 obese patients who achieved weight loss by either diet (n=14), VBG (n=13) or BPD-DS (n=13), before and after weight loss. The follow-up period was 18 months for BPD-DS and VBG and 6 months for diet. Serum ghrelin level was measured by ELISA. RESULTS: BMI was significantly decreased in all 3 groups: 9.2+/-2.4% (P<0.01) following diet, 38.47+/-7.26% (P<0.01) after VBG, and 42.88+/-9.09% after BPD-DS (P<0.01). Serum fasting ghrelin level increased after diet (110.45+/-117.84%, P=0.002) and VBG (65.48+/-92.93%, P=0.001),but decreased after BPD-DS (-21.63+/-28.63%, P=0.019). Leptin concentration decreased and adiponectin increased in all groups. CONCLUSIONS: Unlike after diet or gastric restrictive surgery, BPD-DS is associated with markedly suppressed ghrelin levels, possibly contributing to the weight-reducing effect of this operation. Sleeve gastrectomy seems to be the main cause of this reduction.

Prader-Willi syndrome-associated obesity treated by biliopancreatic diversion with duodenal switch. Case report and literature review.

BACKGROUND: Prader-Willi syndrome (PWS) is a congenital chromosomal disorder characterized by compulsive hyperphagia and the early development of obesity. Obesity is identified as the main cause of morbidity and mortality in PWS individuals. Thus, body weight reduction is of major importance for a prolonged survival. PATIENT-METHOD: A 20-year-old female patient with PWS was referred to our department for surgical treatment of her obesity. At admission, her body weight was 153 kg, and her body mass index (BMI) was 74.33 kg/m(2). The patient underwent biliopancreatic diversion with duodenal switch, as well as cholecystectomy and appendicectomy. The volume of the gastric remnant was 100 mL, and the lengths of the gastric and common limbs were 250 and 60 cm, respectively. RESULTS: Eighteen months after the operation, the patient lost 63 kg with no considerable changes in her eating habits. Her sleep disturbances and sleep apnea disappeared, and her social life dramatically improved. CONCLUSIONS: Biliopancreatic diversion with duodenal switch seems to be a good method for the treatment of PWS-associated obesity because it offers good results in weight loss without the need for revision, good quality of life, and a chance for a prolonged survival.