Incidental Finding of Gastrointestinal Stromal Tumors during Laparoscopic Sleeve Gastrectomy in Obese Patients.

INTRODUCTION: The frequency of incidental pathology found during laparoscopic bariatric surgery has been estimated to be 2%. Gastrointestinal stromal tumors (GISTs) are infrequent lesions and account for less than 1% of all digestive tract tumors. The reported incidence of this type of tumors during bariatric surgery is around 0.8%. The objective of this study was to evaluate incidence, characteristics, and evolution of incidentally found GISTs in patients undergoing laparoscopic sleeve gastrectomy (LSG) for the treatment of obesity. MATERIAL AND METHODS: A retrospective analysis from a prospectively collected database was conducted. Demographic data, clinical data, laboratory tests, preoperative esophagogastroduodenoscopy (EGD), postoperative pathology report from surgical specimen with tumor markers, and patient's outcomes were evaluated. RESULTS: From June 2006 to January 2014, 915 patients underwent LSG at our institution. Five (0.5%) patients were found to have incidental GIST. There were four (80%) women; average age was 59.6 ± 6.3 years (range 46-63). None of them had symptoms that served as orientation for preoperative diagnosis. EGD findings were non-suggestive of this pathology in any of these cases. Superficial chronic gastritis was the most common finding in the endoscopic biopsy (60%). All the tumors found in the surgical specimen were of low or very low risk of malignancy, with less than 5 mitoses per 50 fields, less than 2 cm in diameter, and disease-free surgical margins. Cluster of differentiation (CD) 117 and CD 34 were positive in 100% of the cases. None of the patients required adjuvant therapy after the surgery. At 5-year follow-up, all patients were asymptomatic and disease free. CONCLUSION: The incidence of unsuspected GIST in LSG specimens in our series was low and similar to what has been reported. The lack of symptoms and the preoperative EGD findings were not suggestive of this diagnosis in any case. The degree of tumor malignancy was low in all patients and LSG was the definitive treatment, without recurrence at 5-year follow-up.

Relationship Between Tobacco Use and Weight Loss After Bariatric Surgery.

BACKGROUND: Smoking cessation had been typically associated with weight gain. So far, there are no reports documenting the relationship between weight loss after bariatric surgery and smoking habit. The objective of the study was to establish the relationship between weight loss and smoking habit in patients undergoing bariatric surgery and to analyze weight loss on severe smokers and on those patients who stopped smoking during the postoperative period. METHODS: All patients undergoing laparoscopic sleeve gastrectomy (LSG) with at least 2-year follow-up were included. Patients were divided into three groups: (A) smokers, (B) ex-smokers, and (C) non-smokers. Demographics and weight loss at 6, 12, and 24 months were analyzed. Smokers were subdivided for further analysis into the following: group A1: heavy smokers, group A2: non-heavy smokers, group A3: active smokers after surgery, and group A4: quitters after surgery. Chi-square test was used for statistics. RESULTS: One hundred eighty-four patients were included; group A: 62 patients, group B: 57 patients, and group C: 65 patients. Mean BMI was 34 ± 6, 31 ± 6, and 31 ± 6 kg/m2; mean %EWL was 63 ± 18, 76 ± 21, and 74 ± 22 % at 6, 12, and 24 months, respectively. The subgroup analysis showed the following composition: group A1: 19 patients, group A2: 43 patients, group A3: 42 patients, and group A4: 20 patients. Weight loss difference among groups and subgroups was statistically non-significant. CONCLUSIONS: Our study shows that weight loss evolution was independent from smoking habit. Neither smoking cessation during the postoperative period nor smoking severity could be related to weight loss after LSG.

[Celiac trunk compression syndrome by the median arcuate ligament. Laparoscopic approach]. / Síndrome de compresión del tronco celíaco por el ligamento arcuato mediano. Tratamiento laparoscópico.

Median arcuate ligament syndrome (MALS), or celiac trunk compression syndrome, is caused by extrinsic compression of median arcuate ligament, prominent fibrous bands and periaortic nodal tissue. In many cases is asymptomatic, but it may manifests with symptoms such as postprandial abdominal pain or during exercise, nauseas, vomiting and weight loss. Trough less invasive diagnostic techniques, such as doppler ultrasound for screening and preoperative angiotomograhpy, it is possible to obtain good results, comparable to those with arteriography. Surgical treatment by laparoscopic approach is a safe and effective technique. A symptomatic case that required surgical treatment, a laparoscopic approach, with clinical and imaging improvement after the procedure, is presented.

Síndrome de compresión del tronco celíaco por el ligamento arcuato mediano: Tratamiento laparoscópico

El síndrome del ligamento arcuato medio (SLAM), o síndrome de compresión del tronco celíaco, es causado por la compresión extrínseca del ligamento arcuato medio, bandas fibrosas prominentes y tejido ganglionar periaórtico. En muchas ocasiones es asintomático, pero puede manifestarse con síntomas como dolor abdominal postprandial o durante el ejercicio, náuseas, vómitos y pérdida de peso. Mediante técnicas poco invasivas, como la ecografía doppler color y la angiotomografía preoperatoria, es posible obtener resultados diagnósticos comparables a los de la arteriografía. La cirugía constituye el tratamiento de elección, siendo la vía laparoscópica una técnica segura y eficaz Se presenta un caso sintomático atípico que requirió tratamiento quirúrgico laparoscópico, con mejoría clínica e imagenológica luego del procedimiento.

Median arcuate ligament syndrome (MALS), or celiac trunk compression syndrome, is caused by extrinsic compression of median arcuate ligament, prominent fibrous bands and periaortic nodal tissue. In many cases is asymptomatic, but it may manifests with symptoms such as postprandial abdominal pain or during exercise, nauseas, vomiting and weight loss. Trough less invasive diagnostic techniques, such as doppler ultrasound for screening and preoperative angiotomograhpy, it is possible to obtain good results, comparable to those with arteriography. Surgical treatment by laparoscopic approach is a safe and effective technique. A symptomatic case that required surgical treatment, a laparoscopic approach, with clinical and imaging improvement after the procedure, is presented.

Síndrome de compresión del tronco celíaco por el ligamento arcuato mediano: Tratamiento laparoscópico

El síndrome del ligamento arcuato medio (SLAM), o síndrome de compresión del tronco celíaco, es causado por la compresión extrínseca del ligamento arcuato medio, bandas fibrosas prominentes y tejido ganglionar periaórtico. En muchas ocasiones es asintomático, pero puede manifestarse con síntomas como dolor abdominal postprandial o durante el ejercicio, náuseas, vómitos y pérdida de peso. Mediante técnicas poco invasivas, como la ecografía doppler color y la angiotomografía preoperatoria, es posible obtener resultados diagnósticos comparables a los de la arteriografía. La cirugía constituye el tratamiento de elección, siendo la vía laparoscópica una técnica segura y eficaz Se presenta un caso sintomático atípico que requirió tratamiento quirúrgico laparoscópico, con mejoría clínica e imagenológica luego del procedimiento.(AU)

Median arcuate ligament syndrome (MALS), or celiac trunk compression syndrome, is caused by extrinsic compression of median arcuate ligament, prominent fibrous bands and periaortic nodal tissue. In many cases is asymptomatic, but it may manifests with symptoms such as postprandial abdominal pain or during exercise, nauseas, vomiting and weight loss. Trough less invasive diagnostic techniques, such as doppler ultrasound for screening and preoperative angiotomograhpy, it is possible to obtain good results, comparable to those with arteriography. Surgical treatment by laparoscopic approach is a safe and effective technique. A symptomatic case that required surgical treatment, a laparoscopic approach, with clinical and imaging improvement after the procedure, is presented.(AU)

[Omental hernia through esophageal hiatus simulates mediastinal lipomatous tumor]. / Hernia omental a través de hiato esofâgico que imita tumor lipomatoso mediastinal.

Omental hernia through the esophageal hiatus is extemely infrequent. Paraesophageal hiatal hernia with omentum in the herniary sac mimics a mediastinal lipomatous tumor and differential diagnosis should be made. This diagnosis requires experience and knowledge of the differences between these two pathologies. In the following study we describe the case of an omental hernia and the characteristics that make it different from other pathologies.

Hernia omental a través de hiato esofÔgico que imita tumor lipomatoso mediastinal / [Omental hernia through esophageal hiatus simulates mediastinal lipomatous tumor].

Omental hernia through the esophageal hiatus is extemely infrequent. Paraesophageal hiatal hernia with omentum in the herniary sac mimics a mediastinal lipomatous tumor and differential diagnosis should be made. This diagnosis requires experience and knowledge of the differences between these two pathologies. In the following study we describe the case of an omental hernia and the characteristics that make it different from other pathologies.

Hernia omental a través de hiato esofÔgico que imita tumor lipomatoso mediastinal. / [Omental hernia through esophageal hiatus simulates mediastinal lipomatous tumor].

Omental hernia through the esophageal hiatus is extemely infrequent. Paraesophageal hiatal hernia with omentum in the herniary sac mimics a mediastinal lipomatous tumor and differential diagnosis should be made. This diagnosis requires experience and knowledge of the differences between these two pathologies. In the following study we describe the case of an omental hernia and the characteristics that make it different from other pathologies.