Gastric banding: intraoperative and early postoperative complications and their prevention.

BACKGROUND: Intraoperative and early postoperative complications in patients operated for morbid obesity were assessed. METHODS: 114 morbidly obese patients underwnent gastric banding (non-adjustable or adjustable). The influence of body mass index (BMI), age and preoperative morbidity on the occurrence of postoperative ventilatory disturbances was evaluated. RESULTS: Risk of postoperative ventilatory disorders increased with preoperative cardiovascular disease (p < 0.01), diabetes (p < 0.05), and increasing BMI (p < 0.01). Age, hypertension and pulmonary disease did not influence significantly the risk of complication in this series. There have been no deaths. CONCLUSION: In patients undergoing banding for morbid obesity, the potential for ventilatory complications increases with higher BMI, diabetes and cardiovascular disease in the preoperative comorbidities. Principles for postoperative care were developed.

[Intraoperative enteroscopy--personal experience from 1995 to 2002]. / Intraoperacní enteroskopie--vlastní zkusenosti z období 1995-2002.

Authors present their experience with the intraoperative enteroscopy method--an invasive technique of small bowel examination. It is performed under narcosis at an operating theatre (i.e. in co-operation with surgeon and anaesthesiologist). The endoscopy-performing physician becomes one of the members of the operating team. The advantage of the method is the possibility to examine of the whole small intestine and to solve immediately the pathological findings by endoscopic or surgical intervention. The examination is invasive and the correct indication is mandatory. Authors report their results of 18 intraoperative panendoscopies of small intestine.

[Severe acute pancreatitis]. / Tezká akutní pankreatitida.

The authors present a group of 31 patients with severe acute pancreatitis (SAP) treated by early or late surgery and prophylactic, symptomatic and causal medicamentous therapy of a different extent. The diagnosis of SAP is based above all on examination by CT after administration of a contrast substance into the digestive tract and vascular system. Surgical intervention during the first 2-5 days reduces the mortality substantially. It involves above all removal of necrotic masses and administration of multiple drainage. Repeated rapid revisions of the affected area make open packing possible or the use of Ethizip. In non-surgical treatment administration of broad spectrum antibiotics, vitamins, scavengers of free oxygen radicals, antiphlogistic agents, corticoids, immunopromoting preparations, extensive symptomatic individual medication, large volumes of fluids and adequate parenteral nutrition predominate. Controlled ventilation and haemodialysis are in many patients an integral part of treatment. The mortality was about 42% when treatment was early and adequate. In patients where treatment started late and was inadequate, the mortality was as much as twice as high!

[Gastric perforation as an early complication of surgical myocardial revascularization using extracorporeal circulation]. / Perforace zaludku jako casná komplikace chirurgické revaskularizace myokardu v mimotelním obehu.

The authors describe the case of a man with ischaemic heart disease after revascularization of the myocardium by an aortocoronary bypass using extracorporeal circulation. The early postoperative course was complicated by perforation of a gastric ulcer. The condition was successfully resolved by an urgent operation, suture of the perforated stomach with toilet of the abdominal cavity. In the discussion the authors analyze the causes of the possible development of gastrointestinal complications after cardiac surgery, in particular the influence of extracorporeal circulation and other specific effects during cardiac surgery and during the immediate postoperative period.