Nelson Trelles

Laparoscopic splenectomy for massive splenomegaly: technical aspects of initial ligation of splenic artery and extraction without hand-assisted technique.

A 37-year-old man was referred for massive splenomegaly. In November 2005, he was diagnosed with non-Hodgkins B-cell lymphoma in the setting of splenomegaly and thrombocytopenia. His laboratory results showed a coagulopathy owing to lupus anticoagulant. A computed tomography scan showed a 36 x 26 x 11 cm spleen and a prominent and sinuous splenic artery. The authors performed a laparoscopic splenectomy with an initial ligation of the splenic artery. The patient tolerated the procedure well and was discharged home on the fourth postoperative day in stable condition. Discussed in this paper is the safety and feasibility of the minimally invasive approach in massive splenomegaly.

Gastrocolic fistula after re-sleeve gastrectomy: outcomes after esophageal stent implantation

Gastrocolic fistula after re-sleeve gastrectomy: outcomes after esophageal stent implantation Nelson Trelles, M.D., Michel Gagner, M.D., F.R.C.S.C., F.A.C.S.*, Mariano Palermo, M.D.*, Alfons Pomp, M.D., F.R.C.S.C., F.A.C.S., Gregory Dakin, M.D., F.A.C.S., Manish Parikh, M.D. Department of Surgery, Mount Sinai Medical Center, Miami Beach, Florida Division of Laparoscopic and Bariatric Surgery, Department of Surgery, New York Presbyterian Hospital and Joan and Sanford I. Weill Medical College of Cornell University, New York, New York Received August 10, 2009; revised August 13, 2009; accepted August 13, 2009

Updated Review of Sleeve Gastrectomy

There is a bariatric explosion worldwide to deal with the rising prevalence of morbid obesity. In 1988, Hess and Hess first added the sleeve gastrectomy (SG) and the duodenal switch (DS) as a modification to the biliopancreatic diversion (BPD) to improve clinical outcomes. But the increased morbidity and mortality observed in super-super-obese patients (BMI > 60 kg/m� ) who underwent BPD with DS (BPD-DS) made Gagner and co-workers propose SG as a bridge to gastric bypass or BPD-DS to reduce complications and mortality. The excellent short-term weight-loss outcomes after SG have increased the enthusiasm among surgeons to use it as a definitive treatment for morbidly obese and super-obese patients (BMI > 50 kg/m� ). Neurohormonal and gastric emptying changes may account for its superiority over other re- strictive procedures. Recent reports on mid-term weight-loss outcomes make this procedure a viable option for bariatric surgeons; nonetheless, long-term studies are still required.

Laparoscopic Revisional Hepaticojejunostomy for Biliary Stricture After Open Repair Following Common Bile Duct Injury: A Case Report

Introduction. Incidence of bile duct injury has been reported more frequently following laparoscopic cholecystectomy. Case Report. A 43-year-old female with a past medical history of laparoscopic cholecystectomy that was converted to open because of a common bile duct injury now presents with a stenosis at the hepaticojejunostomy that is causing recurrent cholangitis episodes. After the lysis of adhesions and dissection of the anastomotic area, a stricture was identified. The authors exposed and redid the hepaticojejunostomy with 4-0 Monocryl sutures without tension. The follow-up period was unremarkable. No leaks were documented, and the patient was discharged home on postoperative day 3. Conclusion. After percutaneous or endoscopic procedure failure for the treatment of hepaticojejunostomy strictures, the laparoscopic redo anastomosis is safe and feasible when performed by surgeons who are strongly trained in advanced laparoscopic surgery.

Biliopancreatic Diversion with Duodenal Switch

The aims of the procedure are to restrict the size of the stomach through a vertical gastric resection, to shut off the production of ghrelin by removing the fundus completely (gastric sleeve) and to produce malabsorption by separating the small intestine into an alimentary and a biliopancreatic segment. Both segments run parallel, this way digestive juices (bile, pancreatic juice) and food meet only where the segments are connected to form the so-called common channel. The anastomosis is between 50 and 100 cm from the ileocecal valve.

Laparoscopic revision of gastric banding to biliopancreatic diversion with duodenal switch.

Laparoscopic adjustable gastric banding (LAGB) is the most common bariatric procedure in Europe and regions outside the United States and Canada. However, Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion with duodenal switch (BPD-DS) are becoming more widely used [1]. LAGB is considered a safe and simple procedure for morbid obesity. Despite its low mortality rate, it can result in high morbidity, with a significant number of patients requiring band removal. The weight loss effectiveness and the long-term results of LAGB have also been lower than those with other bariatric procedures [2]. Recently, BPD-DS has shown to be the most effective procedure for morbid obesity, mostly in super-obese and super-super-obese patients [2‐4]. With bariatric surgery gaining popularity among surgeons, more revision operations are being performed to deal with the complications or failure of the primary bariatric procedure. We present a case that illustrates the technical key aspects of laparoscopic revision of LAGB to BPD-DS.