Crura Dissection in Sleeve Gastrectomy
Condition: Post-op Complication Interventions: Procedure: Crura dissection; Procedure: Sleeve gastrectomy; Procedure: Hiatal hernia repair Sponsor: University of Miami Not yet recruiting
We report the case of a 72-year-old man with a history of distal gastrectomy and Billroth I anastomosis due to early gastric cancer. GERD due to bile reflux occurred after surgery and was refractory to medical therapy. The patient underwent Roux-en-Y conversion from Billroth I gastroduodenostomy and hiatal hernia repair with only cruroplasty. Fundoplication was not performed. His symptoms improved significantly after the surgery. Therefore, laparoscopic hiatal hernia repair and Roux-en-Y conversion can be an effective surgical procedure to treat medically refractory DGER after Billroth I gastrectomy. PMID: 33024589 [PubMed]
Authors: Boru CE, Termine P, Antypas P, Iossa A, Ciccioriccio MC, De Angelis F, Micalizzi A, Silecchia G Abstract BACKGROUND: Hiatal hernia repair (HHR) is still controversial during bariatric procedures, especially in case of laparoscopic sleeve gastrectomy (LSG). AIMS: to report the long-term results of concomitant HHR, evaluating the safety and efficacy of posterior cruroplasty (PC), simple or reinforced with biosynthetic, absorbable Bio-A® mesh (Gore, USA). Primary endpoint: PC's failure, defined as symptomatic HH recurrence, nonresponding to medical treatment and requiring revisional surgery. METHO...
This study is the first to compare surgical outcomes and health economic data using nationwide administrative claims datasets for gastric cancer. Methods: The claims datasets of the Health Insurance Review and Assessment Service for patients that underwent gastrectomy from May 2012 to April 2017 were analyzed. A total of 76,445 cases (LS, 42,395 and OS, 34,050) were included. Postoperative complications and medical costs were included in the analysis. Results: We analyzed 76,445 cases of gastrectomy. Analysis showed LS was associated with fewer surgical wound infections (2,114 [6.21%] vs. 1,057 [2.49%], P
CONCLUSIONS: To our knowledge, this is the first report of a heavily pretreated and rapidly progressing deficient MMR gastroesophageal MANEC experiencing a durable benefit from anti-PD1 treatment. PMID: 32878569 [PubMed - as supplied by publisher]
Hiatal hernias are often repaired concurrently with bariatric surgery to reduce risk of GERD-related complications.
AbstractThe development of novel materials with effective defect ‐repairing properties will help avoid subtotal gastrectomy in patients with large gastric perforations. We prepared perfused decellularized gastric matrix (PDGM) and analyzed its components, spatial structure, biomechanics, cytotoxicity, and histocompatibility to validate its efficacy in the repai r of gastric perforation. PDGM retained large amounts of gastric extracellular matrix, while residual glandular cells and muscle fibers were not found. The spatial structure of the tissue was well preserved, while the DNA and glycosaminoglycan contents were signif...
ConclusionLeak after sleeve gastrectomy can be difficult to manage. Chronic leaks do not respond well to non-operative management. Partial gastrectomy with Roux-En-Y reconstruction is a technically challenging option with good results.
Laparoscopic sleeve gastrectomy (SG) is nowadays the most popular bariatric procedure performed for treatment of obesity (1). One of the potential early complication is the gastric leak (2), which remains difficult to be treated especially if it is located in the upper segment of the stomach. The early gastric leak is usually treated by endoscopy with successful results in 67,1-92 % of the cases (3). The endoscopic treatments consist in the placement of self-expanding stents, over-the-scope clips (OTSC), or fibrin glue (3), or to perform endoscopic septotomy (4) or to finally create an endoscopic fistula-jejunostomy (5).
Laparoscopic sleeve gastrectomy (LSG) became the most popular bariatric procedure performed in the obesity field . In front of a postoperative complication, like the gastric leak , there is no standard recommended treatment, hence its management becomes challenging. Treatment, overall if the patient is clinically stable, is by endoscopic placement of endoprosthesis  or double-pigtail drains. Recently, this latter option became popular, with a successful leak closure of 83.41% . Complications related to the deployment of double-pigtails drain include bleeding, ulceration at the tip of the stent, and migration .
Laparoscopic sleeve gastrectomy (SG) became the most popular bariatric procedure performed in the obesity field (1). In front of a postoperative complication, like the gastric leak (2), there is no standard recommended treatment, hence its management becomes challenging. Treatment, overall if the patient is clinically stable, is by endoscopic placement of endoprosthesis (3) or double-pigtail drains. Recently, this latter option became popular, with a successful leak closure of 83,41% (4). Complications related to the deployment of double-pigtails drain include bleeding, ulceration at the tip of the stent and migration (5).