Guillermo Higa

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.

Stapling of orogastric tube during gastrojejunal anastomosis: an unusual complication after conversion of sleeve gastrectomy to laparoscopic Roux-en-Y gastric bypass

The number of laparoscopic Roux-en-Y gastric bypass (LRYGB) cases performed annually in the United States has significantly increased. With the increased number of laparoscopic cases in bariatric surgery, LRYGB has become one of the most technically demanding operations performed in minimally invasive surgery [1]. This procedure is associated with a significant learning curve and, even in expert hands, can be associated with complications. Stapling of the orogastric tube during the performance of gastrojejunal anastomosis is an unusual and dreaded complication in bariatric surgery [2]. Surgeons should maximize their awareness and prevent this complication.

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.

Oclusión vascular mesentérica

La circulacion mesenterica recibe aproximadamente el 25 % del gasto cardiaco en condiciones de reposo. Por consiguiente, es una de las areas circulatorias regionales mas grandes del organismo. La circulacion mesenterica es funcionalmente compleja y el hecho de estar oculta dentro de la cavidad peritoneal dificulta su evaluacion objetiva.

Obstrucción del tracto digestivo

Cualquier patologia organica o funcional que impida de manera primaria o indirecta la propulsion normal del contenido de la luz desde la entrada esofagica hasta el ano deberia considerarse una obstruccion del tracto alimentario ( fig. 75-1 ).