A Comparison of One- and Two-Stage Laparoscopic Sleeve Gastrectomy Following Failed Laparoscopic Adjustable Gastric Banding Using the BAROS Score.

INTRODUCTION: Revision of a failed band can be done by laparoscopic sleeve gastrectomy (LSG). It can be performed synchronously with band removal or during two separate procedures. AIM: Comparing single- and two-staged LSG following a failed LAGB in terms of short- and mid-term outcomes, with an emphasis on postoperative quality of life. METHODS: A retrospective cohort study comparing revisional LSG's safety and efficacy after failed LAGB removal. Data included patients' medical files, as telephone interviews. We compared demographics, weight loss, complications, long-term outcomes, and quality-of-life measures, including the Bariatric Analysis and Reporting Outcome System (BAROS). RESULTS: Ninety-three patients were enrolled, of which 68 (73.1%) underwent a single-stage revisional LSG. Of these, 40 were males (35.1%) with a mean age of 44.9 years (± 12.9). The two-staged group were older. The reasons for band removal differed between the groups: whereas in the two-stage surgery, the common causes were slippage (29.2%) or band intolerance (25%); in the single-stage group, it was weight gain (51%). There were no differences in short- and mid-term complications, weight loss, and quality of life. CONCLUSION: In selected cases, laparoscopic sleeve gastrectomy as a revision of failed gastric banding in one stage is as safe as a two-stage procedure in terms of short- and mid-term complications, weight loss, and quality of life. We believe that there is little benefit in performing elective surgery in two stages unless there are clinical indications. Exceptions for two-stage revision should include cases of band erosion and acute slippage with patient preference for band removal.

Laparoscopic resection of duodenal gastrointestinal stromal tumour.

Only a few studies have revealed using laparoscopic technique with limited resection of gastrointestinal stromal tumour (GIST) of the duodenum. A 68-year-old man was admitted to the hospital due to upper gastrointestinal (GI) bleeding. Evaluation revealed an ulcerated, bleeding GI tumour in the second part of the duodenum. After control of bleeding during gastroduodenoscopy, he underwent a laparoscopic wedge resection of the area. During 1.5 years of follow-up, the patient is disease free, eats drinks well, and has regained weight. Surgical resection of duodenal GIST with free margins is the main treatment of this tumour. Various surgical treatment options have been reported. Laparoscopic resection of duodenal GIST is an advanced and challenging procedure requiring experience and good surgical technique. The laparoscopic limited resection of duodenal GIST is feasible and safe, reducing postoperative morbidity without compromising oncologic results.

Pregnancy outcome in patients with fibromyalgia syndrome.

OBJECTIVE: To investigate pregnancy outcome of patients with fibromyalgia syndrome (FMS). METHODS: A retrospective cohort study comparing pregnancies of women with and without FMS was conducted. Multivariable logistic regression models was performed to control for confounders RESULTS: Deliveries of 112 women with FMS were compared with a control group of 487 deliveries of women without FMS. Parturients with FMS had higher rates of intrauterine growth restriction (IUGR; 7.1% vs. 1.0%, p = 0.001), recurrent abortions (9.8% vs. 1.8%, p < 0.001), gestational diabetes mellitus (14.3% vs. 7%, p = 0.012), and polyhydramnios (12.5% vs. 1.6%, p < 0.001). These patients had lower rates of preterm deliveries (PTD; 6.3% vs. 16.7%, p = 0.018). No significant differences were noted between the groups regarding the rates of cesarean deliveries (CD) (15.2% vs. 21.2%, p = 0.149) and perinatal outcomes such as low Apgar scores (<7) at 1 and 5 min (4.5% vs. 6.7%, p = 0.292 and 1.2% vs. 0.6%, p = 0.372; respectively). Using two multiple logistic regression models, the positive association between FMS and IUGR (adjusted OR = 4.1, 95% CI 1.2-13.2; p = 0.02) and the negative association with PTD (OR = 0.3, 95% CI 0.2-0.6; p = 0.001) remained significant. CONCLUSION: FMS is an independent risk factor for intrauterine growth restriction. Nevertheless, it is associated with lower rates of preterm deliveries.