Bogdan Modzelewski

Laparoscopic sleeve gastrectomy – 7 years of own experience

Introduction Laparoscopic sleeve gastrectomy is a procedure frequently chosen by patients and surgeons that carries the risk of serious complications that are difficult to treat. Aim To describe the operations performed by us, considering complications and their management. Material and methods We performed 565 laparoscopic sleeve gastrectomies. Standard surgical technique was used. A 34 Fr calibration tube was used. An additional reinforcing suture was applied over the staple line. Results There was no need for conversion. In 7.79% of patients, infarcts of the posterior pole of the spleen were observed, whereas 8 patients (1.42%) developed gastric fistulas in the His angle region. In 3 cases, it led to development of an abscess in the posterior splenic pole region and 2 of these developed secondary gastric fistulas of typical location. In total, there were 5 deaths among the patients who had been operated on – 3 due to septic complications in the course of fistula, 1 due to encephalopathy and 1 as a result of myocardial infarction. Conclusions Sleeve gastrectomy is an effective and safe method of obesity treatment. The causes of the most severe complication – gastric fistula – cannot be established unequivocally. Infarcts of the posterior pole of the spleen, as a potential cause of fistulas, deserve particular attention. In our opinion, primary closure of the fistula by suturing is an inappropriate method of management, whereas the best results are obtained with temporary gastrointestinal tract prosthesis.

Gastric perforation as a complication after BioEnterics intragastric balloon bariatric treatment in obese patients--synergy of endoscopy and videosurgery.

The BioEnterics intragastric balloon (BIB) is one of the most common bariatric procedures in obese patients in Europe. Associated gastric perforation is a rare, yet very dangerous, complication. We report a case of such a complication after BioEnterics intragastric balloon insertion in a 60-year-old female patient and subsequent cooperation between an endoscopist and bariatric videosurgeon in her treatment.

Perioperative Comparison of the MiniMizer ® Extra Band with the Other Laparoscopic Gastric Bands

Background: Laparoscopic adjustable gastric banding is a widely used operation for morbid obesity. The most frequent complications of this operation are band migration and pouch dilatation (slippage). The use of the newly introduced MiniMizer® Extra band with a unique gastric wall fixation system and a two-degree closure may decrease the postoperative complication rate. Very early (perioperative) results are hereby reported. Methods: From February 2005 through October 2005, 50 classical bands (Obtech-Ethicon, AMI, Midband, Inamed) and 10 MiniMizer® Extra bands were inserted in our department. Bands were chosen randomly. Complications in the very early postoperative period were studied. Results: No statistically significant differences between surgery times were noted – classical bands mean 36 min (20-60), and MiniMizer® Extra bands mean 34 min (25-55). No statistically different rates of perioperative complications were noted, with only 2 very minor intraoperative complications in the entire series. Conclusions: The absence of problems in the perioperative period allows the use of the MiniMizer® Extra band as an alternative to classical bands for short- and long-term comparison.

Gastric cancer after laparoscopic adjustable gastric banding: case report

Gastric cancer in patients who have undergone bariatric surgery is rare. The authors present a case of stomach cancer in a patient 6 years after adjustable silicone gastric band placement. The tumour was located below the band, not in its direct vicinity. Aetiological and risk factors of stomach cancer incidence in obese patients are discussed in this case study.

The Gastric Banding

One of the treatments for pathological obesity is adjustable gastric banding. An adjustable gastric band is applied to the stomach via laparoscopy ( laparoscopic adjustable gastric banding – LAGB). This is one of the so-called restrictive surgical methods for treating obesity and, in comparison with other techniques of bariatric surgery, is the least invasive for the anatomy of the gastrointestinal tract. The gastric band is used worldwide. It is most popular in Australia, Europe, and South America and is less used in the USA and Mexico. The procedure is based on the idea of dividing the stomach into two parts, the upper part of which has a capacity of 20–50 ml. The width of the passage between these two parts is regulated by filling the gastric band with fluid, making it possible to control the rate of passage of the gastric content from the upper to the lower part of the stomach. Filling of the “upper” stomach produces the feeling of satiety, perceived by the patient as a signal to stop eating. In this way, the volume of food intake and, consequently, the amount of energy supplied to the organism is reduced. Advantages of the gastric band include the small extent of injury associated with the surgical procedure, short duration of the surgery and anesthesia, preservation of the natural anatomy of the gastrointestinal tract, no anastomoses, and preservation of the natural route of the food. Additionally, the possibility of regulating the width of the passage between two parts of the stomach makes it possible to control the rate of weight loss. The disadvantages of the method include the presence of foreign bodies (the gastric band and port), inconvenience for the patient associated with the necessity of periodic regulation of the band volume, complications resulting from compression of the gastric wall by the band (migration), possibility of band displacement (slippage), the presence of the port (causing problems with plastic surgery of the abdominal wall – if it is located on the abdomen, it interferes with physiotherapy and NMR imaging). Moreover, many authors claim that weight loss with this method is insufficient, and it should therefore not be used in patients with a BMI exceeding 50 kg/m2.