Outcomes of a novel bariatric stent in the management of sleeve gastrectomy leaks: a multicenter study.

BACKGROUND: The management of laparoscopic sleeve gastrectomy leaks remains a challenge. This can be treated with placement of self-expandable metal stents, which are most effective in the acute and early settings. However, migration is a frequent adverse event (AE). Novel, fully covered stents with a larger proximal flare to limit migration designed specifically to treat postsleeve leaks were recently introduced. OBJECTIVES: The aim of this study was to evaluate the safety and efficacy of a novel stent specifically designed for postsleeve leaks treatment. SETTING: Multicenter retrospective study. METHODS: This is a multicenter study, including patients with acute and early post laparoscopic sleeve gastrectomy leaks, treated with a large bariatric stent. The outcomes include technical success, clinical success, and safety profile. A multivariable regression was performed to assess predictors of success. RESULTS: Thirty-seven patients were included (10 acute and 27 early leaks), with 30 stents in the postpyloric (POST) and 7 in the prepyloric position. Technical success was 100%. Mean stent dwell time was 29.08 days. Clinical success was achieved in 78.37%. Leak duration, leak size, and stent dwell time did not correlate with clinical success. During follow-up, 8 patients had stent migration (21.62%) and all were in a POST position. AE poststent removal were also evaluated (prepyloric: 57.14% vs POST: 33.3%, P = .45). There was no difference between prepyloric and POST position in the severe AE analysis. CONCLUSIONS: This novel, large-caliber, fully covered stent specifically designed for sleeve leaks appears to be effective at treating acute and early leaks. However, the large flanges and long stent length do not appear to reduce migration rate and may be associated with higher overall severe AE rates. Avoiding placement in the POST position may help mitigate migration risk; however, owing to the risk profile this stent should be used with caution.

Very beyond subjectivity: The limit of accuracy of Q-Graders.

When it comes to the sensory analysis of specialty coffees, it is necessary to discuss the protocol of tests of the Specialty Coffee Association (SCA) and the formation of Q-Graders as reliable parameters in the sensory analysis. However, the training of these Q-Graders and the use of the SCA protocol has generated discussions in the scientific community and demonstrated the importance of talking about the level of professional precision as well as the use of the protocol. This study sought to understand the relation of accuracy and efficiency of the Q-Graders and protocol in the sensory analysis of coffees. Three experiments were carried out to evaluate and test the hypotheses regarding the level of precision in relation to the shift, the number of samples and the judgment abilities of Q-Graders due to the quality of the specialty coffee and nonspecialty coffee. These three experiments were performed by seven Q-Graders in an isolated environment during three consecutive days with 137 specialty coffee samples and 7 nonspecialty coffee samples as defined by the SCA. The results indicate that the Q-Graders present high precision when evaluating excellent and outstanding coffees, as defined by the SCA. In addition, the effect of the shift did not exert fatigue on the Q-Graders. However, evaluation errors were made by the Q-Graders on very good coffee (77.00-80.00 points), which are considered as nonspecialty by the SCA, thus allowing a more in-depth discussion on what would be the boundary between a specialty and nonspecialty coffee. PRACTICAL APPLICATIONS: The article deals with the sensory evaluation process of coffees, and it has great importance to teaching and research institutions in Brazil, the largest producer, largest exporter and the country with the highest concentration of coffee scholars in the world. The article focuses on a new approach and a new way of looking at the sensory evaluation process of coffees, using the methodology of the Specialty Coffee Association to analyze the accuracy and efficiency of the Q-Graders.

Totally NOTES (T-NOTES) transvaginal cholecystectomy using two endoscopes: preliminary report.

BACKGROUND: Clinical applications of transvaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES) are still limited in the literature, mostly case reports performed by hybrid procedures with laparoscopic assistance. Avoiding complications from incisions is the main goal for natural orifice surgery. This study reports on a technique developed at our institution that uses two endoscopes inserted into the vagina to perform a Totally NOTES (T-NOTES) transvaginal cholecystectomy, and describes preliminary results. METHODS: IRB approval was obtained at the institution for transvaginal NOTES clinical trials, and informed consent was obtained. The technique of T-NOTES transvaginal cholecystectomy was clinically applied in four female patients with symptomatic cholelithiasis, and data were prospectively documented. Transvaginal NOTES access was obtained by direct vaginal incision, and two endoscopes were simultaneously introduced in the abdominal cavity. Dissection was accomplished with available endoscopic instruments. Ligation of cystic duct and artery was performed using endoscopic clips. Vaginal closure was achieved using the direct-vision sutured technique. RESULTS: The technique was successfully performed in the four patients. Insufflation and spatial orientation was of good quality. Mean operative time was 210 min. There were no complications during the 30-day follow-up. Postoperative course was uneventful, and patients were released from the hospital on the first postoperative day. CONCLUSION: Tranvaginal T-NOTES using two endoscopes provides a feasible method for natural orifice cholecystectomy using available technology. Large-series studies are needed to evaluate the results with respect to safety of the approach.