RESUMO
Laparoscopic Roux-en-Y gastric bypass (LRYGBP) has been an available operation for weight loss for the past decade, and bariatric surgery is increasing in the United States. Careful patient screening and follow-up have been the cornerstone for success against the complexities of morbid obesity. Neurologic complications have occurred, such as polyneuropathy and Wernicke-Korsakoff syndrome. We report an 18-year-old female with morbid obesity, steatohepatitis, tobacco, recreational drug, and oral contraceptive use who at 4 months after LRYGBP experienced a generalized seizure and stroke. She was diagnosed with an acute ischemic stroke, possibly venous infarction. Her postoperative course had been complicated by malnutrition and dehydration, apparently related to nausea from chronic cholecystitis. She had a possible protein-S deficiency. Rare neurologic complications emphasize the importance of postoperative surveillance in these patients.
Assuntos
Derivação Gástrica/efeitos adversos , Convulsões/etiologia , Acidente Vascular Cerebral/etiologia , Adolescente , Anastomose em-Y de Roux , Infarto Encefálico/diagnóstico , Colecistite/epidemiologia , Doença Crônica , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Comorbidade , Desidratação/etiologia , Feminino , Humanos , Laparoscopia , Imageamento por Ressonância Magnética , Desnutrição/etiologia , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/cirurgia , Deficiência de Proteína S/complicaçõesRESUMO
BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) has a reported learning curve of 100 cases. Robotic-assisted surgery decreases the learning curve in complex laparoscopic surgeries. We hypothesize that robotic-assisted, hand-sewn gastrojejunostomy during a LRYGB will improve results during the initial 100 cases when compared with the literature. METHODS: Our first 100 robotic-assisted gastrojejunostomies performed during LRYGB were reviewed from a prospective database. Patient demographics, operative times, length of stay, reoperations, anastomotic leak, pulmonary embolus, and death were all evaluated. RESULTS: The mean age and body mass index were 42 and 50, respectively. Operative times ranged from 148 minutes to 437 minutes (mean = 254). There were no leaks or deaths. Four patients had complications, including reoperation (1), incisional hernia (1), pulmonary embolus (1), and recurrent umbilical hernia (1). CONCLUSIONS: Robotic-assisted LRYGB is feasible and safe, as evidenced by the excellent outcomes from this series during the initial learning curve for LRYGB.
Assuntos
Derivação Gástrica/estatística & dados numéricos , Robótica , Adulto , Anastomose Cirúrgica/instrumentação , Feminino , Derivação Gástrica/métodos , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
Minimally invasive fellowship training has seen phenomenal growth, with 94 organized fellowship programs in North America. Training experience is varied across programs owing to the differences in surgical practices. Many programs are often weighted to a specific field of advanced laparoscopic surgery, which can limit a fellow's clinical experience. Minimally Invasive Surgeons of Texas (MIST) is a combined organization of four independent private practice and academic MIS fellowships brought together for the common goal of improved fellowship training.