An alternative combined revision of Roux-en-Y gastric bypass: Cover all aspects (of failure)!

ABSTRACT: The revisional surgical techniques for managing weight regain after laparoscopic Roux-en-Y gastric bypass have lacked a clear gold standard. Various methods such as pouch minimising, gastroenterostomy narrowing and distalization have been described, but none have consistently achieved optimal success. This study introduces a combined revision technique that enables the reassessment of both alimentary limb and biliopancreatic limb lengths based on the individual patient's total bowel length. This approach aims to promote effective weight loss while minimising the pouch and gastroenterostomy.

Correct Stapling Technique in Laparoscopic Sleeve Gastrectomy: Are We Increasing the Bleeding? A Prospective Cohort Study.

Introduction: Laparoscopic sleeve gastrectomy (LSG) has become the most common bariatric surgery procedure. Bleeding is the most common complication of this surgery and mostly occurs from the staple line. The aim of this study was to evaluate whether waiting between compression and firing during the stapling phase reduces the postoperative bleeding. Methods: A total of 325 patients who underwent LSG between April and July 2022 were analyzed prospectively. In terms of postoperative bleeding, the two groups, which we waited 30 seconds between staple firings and the no wait group, were compared. Results: The mean age of patients was 37.36 (±11.12) years and mean body mass index was 45.18 (±3.1) kg/m2. Eleven patients needed transfusion. The rate of haemorrhagic complications was 3.38% (Group 1% 6.21 and Group 2% 1.11) (P = .012). The duration of surgery was ∼10 minutes longer in the study group, which we waited (P = .0001). Conclusions: During the stapling stage in LSG, waiting between compression and firing can help reduce postoperative bleeding.

A Case Report of Malaria Infection Following Laparoscopic Sleeve Gastrectomy.

A 41-year-old woman from the Democratic Republic of the Congo underwent laparoscopic sleeve gastrectomy (LSG) as a surgical treatment for obesity. Despite an unremarkable preoperative evaluation, the patient developed a fever and elevated C-reactive protein (CRP) levels postoperatively. Physical examination findings, laboratory tests, and imaging studies ruled out surgical complications, leading to the consideration of infectious causes. A thorough patient history revealed a residence in a malaria-endemic region with a history of recurrent malaria episodes. In addition to her complaints, the patient developed pancytopenia. The blood smear revealed the presence of ring forms of Plasmodium falciparum in red blood cells, along with other species of Plasmodium. The rapid diagnostic test (RDT) showed a positive result for the P. falciparum antigen, a negative result for the P. vivax antigen, and a positive result for the pan-antigen. Based on these findings, a mixed malaria infection was considered for the patient, and she was transferred to an advanced infectious disease hospital for specific typing and further treatment. The patient received prompt treatment and was discharged in stable condition. Malaria could potentially be among the uncommon factors leading to fever after bariatric surgery in patients from malaria-endemic countries. Surgical stress may exacerbate the course of a malaria infection.

Sleeve gastrectomy in situsinversustotalis case.

Laparoscopic sleeve gastrectomy surgery is a procedure that has become more common in the past 10 years. Situsinversustotalis is an extremely rare condition. SG can be performed safely in SIT patients. However, pre-operative multidisciplinary evaluation is very important. In this article, we present a 25-year-old female patient with a body mass index of 47.6 who had no idea that she had SIT until pre-operative tests revealed it. The patient was discharged on the 3rd post-operative day without any problem. We would like to emphasize the importance of imaging even if the patient does not have any disease or risk before bariatric surgery. We believe that more studies should be done with SIT and bariatric surgery.

Acute Intrathoracic Migration With Incarceration of Laparoscopic Sleeve Gastrectomy Due to Incomplete Hiatal Hernia Repair.

Concomitant hiatal hernia repair during laparoscopic sleeve gastrectomy (LSG) is recommended if it is detected. Intrathoracic sleeve migration (ITSM) is a sliding hiatal hernia that develops after LSG. In this article, we present an early ITSM due to an incomplete repair of a hiatal hernia. An obese patient had hiatal hernia in the preoperative endoscopy. After LSG, the defect was repaired with anterior cruroplasty. Vomiting attacks were observed after the operation. Based on clinical signs and radiological findings, laparoscopic exploration was indicated. During the reoperation, an acute entrapment of the upper portion of the sleeve was observed, which had migrated through the hiatus. This suture was undone. There was no gastric ischemia. No additional hiatal repair was attempted. The operation was sufficient to alleviate the symptoms. The patient was discharged on the second postoperative day uneventfully. Until the most recent follow-up, the patient has progressed with adequate weight loss, without complaints of reflux and without proton pump inhibitors ITSM with incarceration is a complication that can occur after incomplete hiatal repair. Failure to perform hiatal repair with proper technique can be attributed to this complication.

Outcomes of conversion from laparoscopy to open surgery in geriatric patients with colorectal cancer: a case-controlled study.

PURPOSE: To evaluate the incidence, risk factors and outcomes of conversion from laparoscopic to open surgery in geriatric patients with colorectal cancer (CRC). METHODS: All patients subjected to laparoscopic procedures for CRC between 2006 and 2018 were included. Patients older than 70 were divided into these necessitating or not necessitating conversion to open surgery (Con>70 and Lap>70 groups, respectively), and those younger than 70 requiring conversion were evaluated in Con<70 group. The results were compared between Con>70 group and the two other groups. RESULTS: Conversion was significantly more common in Con>70 group than Con<70 group (17.3 vs 9.6%, p=0.011). Although female gender and T4 tumors leading to multivisceral resection were significant risk factors for conversion in univariate analysis, multivariate analysis denied any variable as significant. Perioperative outcomes were significantly worse in Con>70 group than those in Lap>70 group. When conversion groups were compared, the rates of surgical site infection and evisceration were higher in geriatric patients. Pathological results revealed that Con>70 group had more advanced tumors than Lap>70 group regarding pT stage, number of malignant lymph nodes and perineural invasion rate. However, the numbers of harvested lymph nodes were similar in two groups. CONCLUSION: Conversion rate is higher in geriatric patients, particularly in female patients and those who necessitate multivisceral resections. Conversion worsens the perioperative outcomes in geriatric patients. Finally, since the number of harvested lymph nodes does not decrease with conversion, it probably does not threaten the quality of oncological surgery.