João Caetano Marchesini

Laparoscopic sleeve gastrectomy with NOTES visualization--a step toward NOTES procedures.

BACKGROUND To demonstrate that bariatric procedures can be done with natural orifice visualization (NOTES) at 2 institutions (Nucleo Universitario de Estudos de Notes Centro de Cirurgia Experimental Vila do Conde-Junqueira, Vila do Conde, Portugal and Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, RS, Brasil). NOTES is a new surgical approach that is being developed. It consists of the use of a minimally invasive technique in which the surgical procedure is performed through natural orifices, thereby circumventing incisions through the skin. METHODS We performed vertical gastrectomy or laparoscopic sleeve gastrectomy in a porcine model using vaginal route visualization. RESULTS A laparoscopic vertical sleeve gastrectomy with NOTES visualization in a porcine model was performed with safety. CONCLUSION Bariatric procedures can be done with NOTES with results as good as those using laparoscopic techniques.

Anemia pós-cirurgia bariátrica: as causas nem sempre são relacionadas à cirurgia

RACIONAL: As anemias ferropriva, perniciosa e megaloblastica sao comuns apos procedimentos bariatricos como o bypass e as derivacoes biliopancreaticas. As principais causas devem-se ao desvio duodenal e do jejuno proximal do trânsito alimentar e, em menor grau, as ulceras anastomoticas. Entretanto a dieta pobre em nutrientes, a suplementacao vitaminica inadequada, medicamentos, uso de alcool e neoplasias devem ser lembrados. RELATO DOS CASOS: Os autores relatam dois casos de pacientes pos-procedimentos bariatricos com anemia severa sem controle clinico e cuja investigacao identificou melanoma metastatico em um caso e neoplasia colonica no segundo, ambos tratados cirurgicamente com bons resultados. CONCLUSAO: Anemias sao comuns apos procedimentos bariatricos, porem causas atipicas como neoplasias devem ser suspeitadas nos pacientes mais idosos e principalmente naqueles refratarios ao controle clinico.

Sleeve gastrectomy leak: endoscopic management through a customized long bariatric stent

re 1. A, Endoscopic view of perigastric cavity and septum below the GEJ. B, Radiographic view of stomach with flow of contrast medium through orifice. C, Totally covered nitinol stent, 200 mm 28 mm 30 mm. D, Radioscopic control: stent positioned 3 cm above GEJ, in a transpyloric er. E, Stent removal: proximal suture grasped by raptor forceps, with removal under radiologic control. F, Radiographic control after stent removal, ing resolution of axis deviation and closure of leak orifice. GEJ, gastroesophageal junction.

Laparoscopic Roux-en-Y gastric bypass with single transumbilical incision - GelPoint®

The innumerable advantages of laparoscopic gastric bypass have stimulated the development of new and less invasive laparoscopic techniques, such as single-incision laparoscopic surgery (SILS). This novel approach provides the introduction of multiple laparoscopic instruments through a single incision at the umbilicus or at a place near the operated structure.1 SILS performed via an umbilical incision produces a better cosmetic outcome than does the traditional (five to seven ports) laparoscopic gastric bypass and probably improves postoperative outcome, because it may diminish trauma to the abdominal wall and peritoneum2,3. Recently, SILS has been gradually adopted in bariatric surgery. Saber et al. reported the first series of patients treated with single-incision laparoscopic sleeve gastrectomy. 4-6

Transenteric ERCP for Treatment of Choledocholithiasis After Duodenal Switch

This article aims to describe step-by-step technique performed with the aid of a video. We report the performance of an endoscopic approach to the biliary tract on 2 patients who had previously undergone duodenal switch (DS). It was successfully performed a laparoscopic-assisted transenteric endoscopic retrograde cholangiopancreatography (ERCP) in both the patients. Although successful experiences with ERCP after Roux-en-Y gastric bypass have been found, few cases of ERCP after DS have been reported. Nevertheless, this is the first study to include a multimedia video with description of details and all technical steps of the transenteric ERCP performed on 2 patients who had previously undergone DS. Transenteric access is a feasible technique for reaching the biliary tract through endoscopy after DS. This technique could avoid most invasive and risky procedures. However, it requires a high level of therapeutic endoscopic training.