RESUMEN
Chyloperitoneum (CP) is a rare complication after bariatric surgery. We present a 37-year-old female with CP caused by a bowel volvulus following a gastric clipping with proximal jejunal bypass for morbid obesity. An abdominal CT image of a mesenteric swirl sign and abnormal triglyceride level of ascites fluid can confirm the diagnosis. In this patient, laparoscopy demonstrated dilated lymphatic ducts caused by a bowel volvulus resulting in the exudation of chylous fluid into the peritoneal cavity. After the reduction of bowel volvulus, she made an uneventful recovery with complete resolution of the chylous ascites. The presence of CP could indicate a situation of small bowel obstruction in patients with a history of bariatric surgery.
RESUMEN
Laparoscopic gastric clipping (LGC) is one of the bariatric surgeries that are minimally invasive and demonstrates effectiveness in reducing body weight for obese patients. However, the patients may later regain body weight and other treatments may be needed. In this case report, two cases with obesity received LGC, which initially reduced their weight. However, they presented with a progressive regaining of body weight a few years after the surgery. Thus, revisional sleeve gastrectomy was conducted in an institute to control their weight regain. Postoperative courses were smooth, and there was no complication. Thus, laparoscopic removal of gastric clipping accompanied with revisional sleeve gastrectomy is technically feasible for the patients.
RESUMEN
PURPOSE: Laparoscopic gastric clipping (LGC) is a relatively novel restrictive bariatric surgery wherein a horizontal metallic clip is applied to the gastric fundus. Its intraoperative complications or the difficulties associated with the applied gastric clip (GC) during revisional procedures have seldom been mentioned. Herein, the experience of revisional procedures after initial gastric clipping is reported. MATERIALS AND METHODS: A retrospective cohort review of LGC based on the Taiwan Bariatric Registry of Taiwan Society Metabolic and Bariatric Surgery was performed. Six patients with severe obesity presented for revisional surgery after initial LGC by other surgeons. Patients' characteristics, indications, and details of revisional surgery were recorded. RESULTS: Between 2012 and 2019, 39 patients who underwent pure LGC and six patients with previous LGC history were referred for revisional surgery. Their mean age and the mean body mass index were 34.7 ± 9.5 years and 38.4 ± 10.5 kg/m2, respectively. Three, two, and one patient underwent revisional surgery for insufficient weight loss, weight recidivism, and intractable belching, respectively. The mean interval between initial LGC and revisional surgery was 40.5 ± 22.4 months. Laparoscopic removal of the GC with concomitant revisional surgeries were collected, including a revision to sleeve gastrectomy (n = 5) and revision to Roux-en-Y gastric bypass (n = 1). Moreover, the mean operative time was 286.8 ± 78.2 min. All patients had uneventful recovery postoperatively but experienced significant adhesion around the GC and the left liver. CONCLUSION: Laparoscopic revisional surgery with concomitant GC removal for patients with severe obesity after gastric clipping could be feasibly conducted by experienced bariatric surgeons.
Asunto(s)
Derivación Gástrica , Laparoscopía , Obesidad Mórbida , Gastrectomía , Humanos , Obesidad Mórbida/cirugía , Reoperación , Estudios Retrospectivos , Taiwán/epidemiología , Resultado del TratamientoRESUMEN
BACKGROUND: Bariatric surgery, the most effective strategy to manage morbid obesity, has increased rapidly in the face of expanding obese population in the twenty-first century. Hence, it is reasonable to expect a rise in the need for revisional bariatric surgery (RBS), especially due to weight recidivism. METHOD: In this video report, the patient was a 28-year-old Asian female with an initial BMI of 42.6 kg/m2 and underwent primary bariatric surgery of laparoscopic gastric clipping with proximal jejunal bypass (GC-PJB) in January 2018. She had the nadir BMI of 35.2 kg/m2 in August 2019. However, she regained weight and her BMI rebounded to 43.7 kg/m2 at the time of consultation for RBS in 2021. After a multidisciplinary team evaluation, laparoscopic procedures of removal of gastric clip and single anastomosis sleeve ileal (SASI) bypass with preservation of previous jejunojejunal anastomosis were performed. RESULTS: The operative time was 216 min and blood loss was 25 ml. There were no intraoperative or postoperative complications. The patient had an uneventful postoperative course and was discharged 4 days after surgery. At the 3-month follow-up after RBS, the patient had lost 25 kg (weight dropped from 119 to 94 kg), and the corresponding BMI was 34.5 kg/m2. CONCLUSION: Laparoscopic removal of gastric clip and SASI bypass with preservation of previous jejunojejunal anastomosis is technically feasible and promising as a revisional procedure for failed GC-PJB.
Asunto(s)
Derivación Gástrica , Laparoscopía , Obesidad Mórbida , Adulto , Femenino , Gastrectomía , Derivación Gástrica/métodos , Humanos , Obesidad Mórbida/cirugía , Reoperación , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
PURPOSE: Laparoscopic gastric clipping is a relatively novel bariatric surgical procedure, which can yield significant weight loss via a restriction of gastric expansion. Medical literature regarding the postoperative complications of this procedure is currently scarce. To this end, we submit here a video presentation of a corrective laparoscopic gastric sleeve procedure performed after an initial gastric clipping that failed to provide adequate weight loss and led to intractable belching. MATERIALS AND METHODS: A 40-year-old, morbidly obese woman (initial body mass index is 35.3 kg/m2) presented with intractable belching and minimal weight loss 6 months after initial laparoscopic gastric clipping at another institution. A laparoscopic revisional procedure with gastric clip removal and conversion to sleeve gastrectomy was conducted to relieve her condition. RESULTS: The procedure took 270 min without any intraoperative complications. Blood loss was recorded at 100 mL. The patient had an uneventful postoperative course with a postoperative hospital stay of 2 days. The patient's symptoms were relieved successfully after this revisional surgery. CONCLUSION: Laparoscopic removal of gastric clip with concomitant revision to sleeve gastrectomy is technically feasible in our patient.