Eric Sejor

Gastric necrosis: a rare complication of gastric banding.

In the last decade, laparoscopic gastric banding has become an increasingly popular surgical option for morbidly obese patients, because of the minimally invasive and easy surgical technique, its reversibility, and the possibility to calibrate the stoma. Gastric necrosis, as a complication of laparoscopic gastric banding, has been only rarely reported. Herein described is the case of a 45-year-old obese patient with gastric necrosis occurring 2 years after the placement of the band. After initial conservative management, the patient underwent urgent surgery. A huge anterior gastric prolapse through the band was found to be responsible for necrosis of the herniated stomach. An upper polar gastrectomy was performed. The mechanisms responsible for this life-threatening complication are discussed.

Laparoscopic sleeve gastrectomy: how I do it.

Laparoscopic sleeve gastrectomy (LSG) is considered a straightforward procedure but the surgical technique is one of the major determinants of the success of this procedure. We describe a 3-port approach to LSG that was adopted in 750 consecutive cases. The LSG was completed with 4 cartridges in 712 cases (95%) and was associated with a 4.8% rate of complications including a 2.4% rate of leak. The surgical technique is described in detail and the inherent advantages are discussed.

Postoperative Mortality After Bariatric Surgery: Do the Numbers Reflect the Reality?

Obesity has emerged as a major public health problem worldwide in the last decade. Surgery has proven to be the only effective sustained weight loss option for many patients. The number of bariatric procedures has substantially increased every year in the last decade. In France, 47,084 patients underwent a bariatric intervention in 2014, which represents almost the quadruple of interventions done in 2005 [1]. The postoperative mortality rate in bariatric surgery has significantly decreased during the last decade. Recent data from the United States National Inpatient Sample has shown that in-hospital mortality has dropped from 0.8 % in 1998 to 0.07 % in 2012 [2]. We recently reported that in-hospital mortality after bariatric surgery in France was as low as 0.038% in 2014 [1]. There are several reasons for the decrease in the mortality rate. First, the volume of surgery has increased substantially during the past decade, and volume has been shown to be a major predictor of outcome. In a study examining the relationship between hospital volume and outcomes in bariatric surgery, Nguyen and colleagues reported that the observed mortality was considerably lower at high-volume compared with low-volume hospitals (0.3 vs 1.2 %, respectively) [2]. Second, innovations in bariatric surgical techniques lead to better preparation and selection of patients. Lastly, the quality and efficacy of the staplers and the vessel sealing devices have substantially improved [3]. National registry and international societies have been created in the effort to collect, publish, and compare bariatric surgery data, including postoperative mortality. Analyzing the results of postoperative mortality, several problems emerge. First of all, the definition of postoperative mortality is not homogeneous: some authors report inhospital mortality [1] whereas others report 30-day mortality [4], and others 90-day mortality [5]. It is clear that we cannot compare results if definitions are so different. Second, fast-track and enhanced recovery is substantially spreading in the field of bariatric surgery, leading to shorter hospitalization periods and even to the introduction of ambulatory bariatric procedures. Consequently, mortality during hospitalization is less frequent, and it may be difficult to detect all postoperative deaths. Readmission may be coded differently, and the eventual postoperative death may escape the count. Third, the centralization of bariatric procedures may lead low-volume centers to transfer patients who develop serious complications to high-volume referral centers. As a result, all these factors may lead to underestimate the results of postoperative mortality. * Tarek Debs dr.debs@hotmail.com

Migration of an Endoscopic Double Pigtail Drain into the Abdominal Wall Placed as a Treatment of a Fistula Post Revisional Bariatric Surgery

Laparoscopic Roux-en-Y gastric bypass (RYGB) is a commonly performed bariatric procedure for the surgical management of morbid obesity [1].Weight regain and failure are more frequently encountered leading to an increase in revisional surgery [2–4]. Reoperation is associated with an increased rate of complications. Staple line leak after revisional bariatric surgery is a more common and a more challenging complication to treat [3]. Endoscopic internal drainage with double pigtails has been shown to be effective [4]. However, physicians should be aware of the possible complications of this technique.

Complications after laparoscopic Sleeve Gastrectomy: can we approach a 0% rate using the largest staple height with reinforcement all along the staple line? Short-term results and technical considerations

BACKGROUND Laparoscopic sleeve gastrectomy (SG) is gaining acceptance among bariatric surgeons as a viable option for treating morbidly obese patients. We describe the results of a single centers experience with SG, revealing a low complication rate. OBJECTIVES The aim of the study was to analyze the short-term results of laparoscopic SG using exclusively black staples with staple-line reinforcement. SETTINGS University hospital, tertiary referral center for bariatric surgery. METHODS SG was performed in 434 consecutive patients from December 2014 to March 2017. A technique is described where all operations were performed with attention to avoiding strictures at the incisura angularis and not stapling near the esophagus at the angle of His. All the interventions were performed using black cartridges and staple-line reinforcement using bioabsorbable Seamguard. A prospective chart review was conducted to determine the occurrence of early complications. RESULTS Follow-up data were collected for all patients at 90 days postoperatively. A total complication rate of 4.4% was observed. No leaks occurred in any of the patients. One case of bleeding occurred that necessitated a surgical exploration, which found the origin of the bleeding to be a diaphragmatic vessel. The 90-day mortality rate was 0%. CONCLUSION SG can be performed with a low complication rate. Selection of the appropriate staple height and reinforcement of the staple line could play a major role in optimizing the results of SG.

Iatrogenic venous air embolism from central venous catheterization after blunt liver trauma

A 53-YEAR-OLD MAN presented to our trauma center after a motor vehicle accident. Upon presentation, the patient had a Glasgow coma scale of 9 (2 + 5 + 2). The clinical examination showed a distended and painful abdomen in addition to an open fracture of the right arm. The patient was hemodynamically unstable, hypotensive (blood pressure 80/50 mm Hg) and tachycardic (125 beats per minute). He was directly intubated, and fluid resuscitation via a right femoral vein central venous catheter was started. Administration of blood transfusions and vasopressor agents was needed. Focused assessment with sonography for trauma confirmed a hemoperitoneum. The patient was transferred to the operating room for emergency laparotomy. Peroperatively, an abundant hemoperitoneum (1.5 L) was found with active bilobar hepatic bleeding. No other injuries were identified. Liver packing was performed. Postoperatively, total body computed tomography revealed a grade IV liver injury, with parenchymal disruption involving segments IV, VII, and VIII, a subcapsular hematoma of segment VII, a mild right hemothorax, second to sixth right rib fractures, a right adrenal gland

Leak of the Bypassed Stomach after Laparoscopic Gastric Bypass, Presenting as Abdominal Wall Cellulitis

The development of surgical staplers devised for laparoscopy has enabled advancements in complex laparoscopic procedures, such as gastric bypass. This procedure, considered by many as the gold standard for bariatric surgery, is now frequently performed laparoscopically, with the advantages inherent in the minimally invasive approach. Technical failure of surgical staplers is, however, a well known complication of these devices in digestive surgery. We report the case of a leak of the bypassed stomach into the abdominal wall through a trocar site following laparoscopic gastric bypass. The mechanisms responsible for this life-threatening complication and the options to avoid it are discussed.