Elias Chousleb

Routine Abdominal Drains After Laparoscopic Roux-en-Y Gastric Bypass: A Retrospective Review of 593 Patients

Background: The authors reviewed the benefits of routine placement of closed drains in the peritoneal cavity following laparoscopic Roux-en-Y gastric bypass (LRYGBP). The purpose of the study was to determine whether routine closed abdominal drainage provides diagnostic and therapeutic advantages in the presence of complications such as bleeding and leaks. Materials and Methods: The medical records of 593 consecutive patients who had undergone LRYGBP from July 2001 through May 2003 were retrospectively reviewed. In all cases, antecolic antegastric LRYGBP was performed. Two 19-Fr Blake closed suction drains were left in place, one at the gastrojejunostomy and the other at the jejunojejunostomy. The incidence of bleeding and leaks was reviewed, and the utility of the drains relative to diagnosis and management was evaluated. Results: Bleeding presented in 24 patients (4.4%); in 8, the diagnosis was based on increased sanguinous output from the drain and decreased hematocrit. None of the patients with intraabdominal bleeding required reoperation. Of the 10 patients (1.68%) who presented with leaks, the diagnosis was made within 48 hours postoperatively in 5 patients (50%), based on the characteristics of the drain output. Nonoperative management with drainage and total parenteral nutrition was accomplished in 5 (50%) of the 10 patients with leaks. There was no mortality in the series. Conclusion: The routine use of abdominal drains after LRYGBP appears to be beneficial. Drains allowed early diagnosis of complications and in most cases, the successful treatment of leaks. When bleeding is suspected or documented, appropriate volume replacement therapy is mandatory to maintain adequate hemodynamic parameters. Drain output may orient the surgeon to take preventive measures such as discontinuing anticoagulation and early fluid resuscitation. In this series, in most cases the bleeding spontaneously stopped and no further surgical management was required.

Laparoscopic removal of gastric band after early gastric erosion: case report and review of the literature.

Laparoscopic gastric banding is a popular method for treating morbid obesity. One of the most serious complications is band erosion into the gastric lumen. We present the case of a patient who underwent gastric banding and presented with symptoms of gastrointestinal reflux and mild-to-moderate hypertension, fever, and pain. UGI revealed stomach wall erosion and partial migration of the band into the gastric lumen. The band was laparoscopically removed without any further complications. Migration after laparoscopic gastric banding must be immediately addressed to prevent infection. Close monitoring of the band location during adjustments as well as a high index of suspicion is necessary.

Laparoscopic Roux-en-Y duodenojejunal bypass for superior mesenteric artery syndrome: case reports and review of the literature.

Introduction: Superior mesenteric artery syndrome is a clearly defined and uncommon medical condition. Surgical intervention is needed for failed long-term medical management. Material and Methods: We report a series of 3 cases, a 17-year-old woman, a 23-year-old man, and a 50-year-old woman that were successfully treated by Roux-en-Y duodenojejunal bypass using a laparoscopic approach. Technique: A 5-trocar laparoscopic approach was used for the surgery. A 75 cm long Roux limb was used in all cases. Results: The postoperative period was unremarkable and symptoms of obstruction subsided in all 3 cases. Conclusions: Laparoscopic duodenojejunal bypass seems to be a feasible and safe treatment option for superior mesenteric artery syndrome.

Laparoscopic Management of Intestinal Obstruction

Laparoscopic adhesiolysis is a valuable tool for the surgeon performing complex minimally invasive procedures. It can be used for the management of intestinal obstruction and chronic abdominal pain syndromes. It is also an essential skill when performing laparoscopic surgery on patients who had prior abdominal operations. The use of laparoscopy for patients with an intestinal obstruction was once considered an absolute contraindication. With the advancement in optics and increasing experience, more and more surgeons are turning to laparoscopy as a useful diagnostic and therapeutic tool in more complex situations.

Myasthenia gravis improvement after laparoscopic Roux-en-Y gastric bypass.

Many diseases in the obese population have been found to improve after weight loss. A 56-year-old female with a long history of myasthenia gravis (MG) and morbid obesity is reported. Preoperatively, she presented with a BMI of 46.5 kg/m2, and was on three medications and IV immunoglobulin every 5 weeks. After the surgical procedure, she improved and required less medication. Because MG and morbid obesity require careful perioperative management in order to avoid complications, a multidisciplinary approach is recommended.

Management of Post-Bariatric Surgery Emergencies

Management of post-bariatric surgery emergencies is common practice in the USA and the world. Due to the popularity and widespread use of bariatric procedures to treat obesity and its comorbidities, emergency physicians and general surgeons will be challenged with the treatment of short- and long-term complications of bariatric procedures. In this article, we evaluate the most common long-term complications of the most commonly performed bariatric interventions.

Balancing Complications and Metabolic Benefit

Bariatric surgery emerged as an effective way to treat morbid obesity, and it was rapidly recognized to have the capability to improve diabetes mellitus type 2 (T2DM), reduce cardiovascular events, and improve survival (Buchwald et al. Am J Med 122: 248, 2009; Sjostromk et al. JAMA 307: 56–65, 2012; Adams et al. N Engl J Med 357: 741–752, 2007; Halperin and Goldfine. Curr Opin Endocrinol Diabetes Obesity 20: 98–105, 2013). It has been suggested that 84 % of the patients with diabetes will undergo long-term remission after RYGB (Jurowich et al. Obes Surg 22: 1521–1526, 2012). The bariatric procedures most commonly performed are Roux-en-Y gastric bypass (RYGB), laparoscopic adjustable gastric band (LAGB), laparoscopic sleeve gastrectomy (LSG), and biliopancreatic diversion (BPD), each with different magnitude in the excess weight loss, but with sustainable long-term results compared with medical group alone.

Hernias internas: Hernias intraperitoneales congénitas

La mayoria de las hernias intraperitoneales derivan de variantes anatomicas que habitualmente estan presentes en el momento de nacer ( fig. 88-1 ). Las hernias que se desarrollan secundariamente a alteraciones en la rotacion intestinal normal durante el desarrollo embriologico presentan sacos. Por lo general, estos tipos de hernias son paraduodenales o mesocolicas. Las hernias que se desarrollan a traves de defectos en el mesenterio o el peritoneo carecen de sacos. Estos tipos de hernias incluyen las que tienen lugar a traves del orificio epiploico, los defectos congenitos en el mesenterio del intestino delgado y grueso y, con menor frecuencia, defectos en los ligamentos anchos del utero.