RESUMO
Gastric bypass surgery is a common and effective procedure for obesity and associated comorbidities. However, long-term complications, such as internal hernias, can pose diagnostic and therapeutic challenges. Internal hernias after gastric bypass are rare but can lead to severe complications, including volvulus and bowel ischemia. Understanding the anatomical variations and employing laparoscopic techniques for resolution are crucial in managing these cases.
Assuntos
Derivação Gástrica , Hérnia Interna , Laparoscopia , Obesidade Mórbida , Humanos , Laparoscopia/métodos , Hérnia Interna/cirurgia , Derivação Gástrica/efeitos adversos , Derivação Gástrica/métodos , Feminino , Obesidade Mórbida/cirurgia , Herniorrafia/métodos , Resultado do Tratamento , Complicações Pós-Operatórias , AdultoRESUMO
BACKGROUND: We had previously described a left lateral segment hyper-reduction technique capable of sizing the graft according to the volume of the abdominal cavity of the recipient. AIM: The purpose of our study was to evaluate our 14-year live-donor liver transplantation experience with in situ graft hyper-reduction in children under 10 kg of weight. PATIENTS AND METHODS: Between January 1997 and May 2011, we performed 881 liver transplants. Two hundred and seventy-seven (n = 277) involved pediatric recipients, of which 102 (37 %) were from live donors. Thirty-five (n = 35) patients under 10 kg of weight underwent hyper-reduced living donor liver transplants. There were 21 females (60 %) and 14 males (40 %), with a median age of 12 months (range 3-23) and a median weight of 7.7 kg (range 5.6-10). RESULTS: Median operative time was 350 min (range 180-510). Median cold ischemia time was 180 min (range 60-300). Twenty-six (n = 26) patients required intraoperative transfusion of blood products. There were 49 postoperative complications involving 26 patients (74 % morbidity rate). One-, 3-, and 5-year survival rates were 87, 79, and 74 %, respectively. Twenty-eight patients are currently alive. CONCLUSIONS: Hyper-reduced grafts provide an alternative approach for low-weight pediatric recipients. The relatively high immediate postoperative morbidity could be related to the complexity of these patients.
Assuntos
Peso Corporal , Falência Hepática/cirurgia , Transplante de Fígado/métodos , Fígado/patologia , Argentina , Feminino , Humanos , Terapia de Imunossupressão/métodos , Lactente , Falência Hepática/congênito , Doadores Vivos , Masculino , Tamanho do Órgão , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Taxa de Sobrevida , Coleta de Tecidos e Órgãos/métodos , Ultrassonografia de IntervençãoRESUMO
PURPOSE: Laparoscopic gastric plication (LGP) is a relative new bariatric procedure with a high revision rate, mostly to sleeve gastrectomy. There are few reported cases of conversion to Roux-en-Y gastric bypass (RYGB). The purpose of this video was to show the feasibility and safety, as well as the main technical aspects, of a laparoscopic conversion of gastric plication to RYGB. MATERIALS AND METHODS: A 40-year-old morbidly obese woman with a previous LGP, consulted for insufficient weight loss, weight regain, and gastroesophageal reflux disease (GERD) symptoms, and was converted to RYGB. RESULTS: Surgical technique included lysis of adhesions between the stomach and the greater omentum, take down of the plication, partial gastrectomy of the devascularized fundus and body and conversion to RYGB. At 30 months, she has achieved a total weight loss (TWL) of 42.43% with no GERD symptoms recurrence. CONCLUSION: Conversion to RYGB is a safe and effective option to treat weight recidivism and GERD after LGP.
Assuntos
Derivação Gástrica , Laparoscopia , Obesidade Mórbida , Adulto , Feminino , Gastrectomia , Humanos , Obesidade Mórbida/cirurgia , Reoperação , Estudos Retrospectivos , EstômagoRESUMO
This video shows the case of a 64-year-old morbidly obese woman, with a non-adjustable gastric band, who consulted for weight regain and gastroesophageal reflux disease (GERD) symptoms and was converted to Roux-en-Y gastric bypass (RYGB). The operative technique included extensive lysis of adhesions, complete band dissection, partial gastrectomy of the fundus and body due to band erosion and conversion to RYGB.
Assuntos
Cirurgia Bariátrica , Derivação Gástrica , Laparoscopia , Obesidade Mórbida , Feminino , Gastrectomia , Humanos , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Reoperação , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Argentina was able to anticipate public health interventions in order to flatten the contagion curve of CoViD-19. Eighty-three surgeons answered an online survey to assess the impact of the pandemic on bariatric surgery (BS) in Argentina. Most of them showed a high economic dependence on BS. Near 90% of health institutions were on phase 0 or I. While 90% still performed other laparoscopic surgeries, BS was suspended. In many surgeries for nonsuspected CoViD-19 patients, high personnel protection resources were applied. Ninety-five percent offered virtual consults. Most surgeons would not change usual algorithms or techniques. To restart BS a scientific society recommendation was expected, including patient selection criteria. The opinions gathered by this survey were taken into account to elaborate official recommendations for restarting elective BS.