Jorge Rabaza

Helicobacter pylori Infection in Patients Undergoing Gastric Bypass Surgery for Morbid Obesity

Background: Studies suggest that the incidence of Helicobacter pylori infection in obese patients, including those undergoing gastric reduction surgery, may be increased. Methods: We examined the histologic findings at the time of surgery in a series of patients who were undergoing Roux-en-Y gastric bypass (RYGBP) for morbid obesity and compared these results with patients in our institution undergoing endoscopy. Results: Of 60 patients undergoing RYGBP,material for histologic examination was available in 56 cases, and in 40 cases gastric fundic mucosa from the anastomotic site was sampled at the time of surgery. Active chronic gastritis was present in 6 (15%), and chronic gastritis was present in 27 (68%). H. pylori was present in all 6 cases of active chronic gastritis and in 9 cases of chronic gastritis (total 38%).This incidence of H. pylori infection was higher than that found in the series of gastric biopsies (107/500, 21%, p = 0.03) and fundic biopsies (10/80, 13%, p = 0.003), but was not different when compared with age-matched gastric biopsies (44/177, 25%, p = 0.12). Conclusions: The incidence of H. pylori in patients undergoing RYGBP was higher than that found in all patients undergoing endoscopy and biopsy and than those undergoing fundic biopsies, but not higher when age-matched controls were considered.

Laparoscopic ventral hernia repair with primary closure versus no primary closure of the defect: potential benefits of the robotic technology

Some authors recommend primary closure of the defect before placement of the mesh. The purpose of this study is to compare laparoscopic ventral hernia repair (LVHR) without primary closure of the defect (NPCD) versus LVHR with primary closure of the defect (PCD).

Robotic repair of giant paraesophageal hernias.

This report suggests that robotic repair of giant para-esophageal hernia has a lower recurrence rate than standard laparoscopic methods, but complications and mortality are similar to standard laparoscopic approaches.

Laparoscopic Management of Gastric Torsion After Sleeve Gastrectomy

Introduction: Gastric volvulus occurs primarily when the stomach suffers torsion on itself due to laxity, elongation, or agenesis of the stomach ligamentous attachments or secondary to diaphragmatic hernias. Gastric torsion after sleeve gastrectomy is a rare complication. We present a case report of 3 patients with gastric torsion after sleeve gastrectomy. Case Description/Technique Description: Three patients with gastric torsion after sleeve gastrectomy were identified. Time between sleeve gastrectomy and gastric torsion symptomatology was 25, 211, and 98 days. Endoscopy established the diagnosis in all patients. Operative findings were organoaxial torsion due to adhesions of the sleeve’s staple line to the liver in all cases. Gastropexy was required in 1 case after laparoscopic lysis of adhesions. Recovery was uneventful for all patients, without torsion recurrence. Discussion: Because sleeve gastrectomy alters the normal stomach attachments, gastric torsion must be considered after sleeve gastrectomy in patients with any degree of obstruction symptoms, at any time of the postoperative course. Endoscopy is a valuable tool for the diagnosis. Laparoscopic torsion reduction by lysis of adhesions is successful, with or without gastropexy.