A Oria

Laparoscopic Sleeve Gastrectomy as an Alternative to Gastric Bypass in Patients with Multiple Intraabdominal Adhesions

BackgroundLaparoscopic sleeve gastrectomy and its indications are currently being evaluated. The objective of this study was to show the preliminary results obtained with this technique indicated as an alternative to gastric bypass in patients with multiple intraabdominal adhesions, therefore preserving the benefits of the laparoscopic approach.MethodsAn analysis of all patients who underwent a laparoscopic sleeve gastrectomy for the above indication was done. Data included demographics, number of previous surgeries, operative time, morbidity, mortality, and %EWL at 3 and 6xa0months.ResultsFifteen patients underwent laparoscopic sleeve gastrectomy as an alternative to gastric bypass because of multiple intraabdominal adhesions. No patient required conversion to an open procedure; morbidity was 6% with no mortality. %EWL at 3xa0months was 41% and at 6xa0months was 44%. Mean follow-up was 6xa0months.ConclusionIn our initial experience, laparoscopic sleeve gastrectomy proved to be a safe and effective alternative to gastric bypass for patients with multiple intraabdominal adhesions.

Laparoscopic Bile Duct Reexploration for Retained Duct Stones

BackgroundFailure of endoscopic sphincterotomy (ES) for retained bile duct stones occurs in 4% to 10% of cases and was traditionally managed with open bile duct reexploration.MethodsThis study uses retrospective analysis of a consecutive series of cases of laparoscopic bile duct reexploration for retained bile duct stones after unsuccessful ES.ResultsThirty-one cases were operated over a 7-year period. Seventy percent had a previous open cholecystectomy. Ten cases were successfully treated with a transcystic approach and 19 with laparoscopic choledochotomy. Two patients were converted to open surgery. Morbidity was 3.22% with no mortality.ConclusionLaparoscopic bile duct reexploration can be safely performed and should be considered as an alternative to open surgery.

Changes in Gastrosplenic Circulation and Splenic Function after Distal Pancreatectomy with Spleen Preservation and Splenic Vessel Excision

IntroductionDistal pancreatectomy with spleen preservation and splenic vessel excision is a commonly used technique. However, it produces significant gastrosplenic circulation and splenic function changes.PurposeThe aim of this work was to determine the immediate consequences on gastrosplenic circulation, late consequences on splenic function, and development of varicose veins.MethodsThirty-five patients with pancreatic tumors and anatomical feasibility were included. Preoperative splenic circulation was evaluated by dynamic contrast-enhanced computed tomography (CT) scans. Early splenic perfusion was assessed by CT 7xa0days after surgery and late changes in gastrosplenic circulation 6xa0months after surgery. Varicose veins were evaluated by CT and endoscopy 6xa0months after surgery. Pitted cells and Howell–Jolly bodies were used as markers of splenic function. Postoperatory findings included changes in splenic perfusion 7xa0days and 6xa0months after surgery, development of varicose veins on CT scans and endoscopy, and detection of markers of splenic hypofunction on blood smears.Results and ConclusionSeven days after surgery, 63xa0% of patients had some degree of splenic hypoperfusion, and 6xa0months after surgery, 83xa0% of patients had normal perfusion. CT scans showed varices in 26 patients, and endoscopy revealed varicose veins in 11. Two patients experienced bleeding; markers of splenic hypofunction were found in 59xa0% of cases.