Oleg Dukhno

Gastric outlet obstruction caused by total band erosion

Laparoscopic adjustable gastric banding for the treatment of morbid obesity has gained widespread popularity because of its simplicity both for the surgeon and more so for the patient. On the other hand, with this procedure there are complications such as band slippage, erosion, balloon problems and tubing problems, which have required reoperations for remedy. Herein we describe a case of band erosion into the stomach causing gastric outlet obstruction. Of particular interest are the clinical appearance and the operative management of this complication.

Our experience with 250 laparoscopic adjustable silicone gastric bandings.

Background: In 1999, after having performed more than 2500 open bariatric surgery procedures, we began to conduct the laparoscopic adjustable silicone gastric banding (LASGB) procedure. The purpose of this report is to present the results of our first 250 operations using this technique. Patients and methods: The 250 patients included 212 females and 38 males. The mean age was 36 years (range, 16–62). The mean BMI was 44 (range, 35–76). Patients were selected in accordance with standard criteria. The mean follow-up time was 18 months (range, 3–24). Results: Two hundred and forty procedures were completed by laparoscopy; conversion to open surgery was required in 10 cases. The mean operating time was 50 min (range, 20–145). There was no mortality. Perioperative complications included two cases of gastric perforation. Late complications included 13 cases of band slippage (5%), of which three involved penetration to the stomach, five cases of port disconnection (2%), and four cases of port site infection (1.5%). The mean weight loss at 12 months was 70% of the original excess weight. Conclusion: Most patients prefer laparoscopy as the surgical technique in the treatment of morbid obesity. Our initial experience with 250 operations confirms that this approach is as good as open surgery. The long learning curve is steep, requiring at least 100 cases to guarantee low complication rates.

The laparoscopic option in the management of peritoneal dialysis catheter revision

BackgroundLong-term functioning of peritoneal dialysis catheters (PDCs) depends on maintenance of pelvic positioning and prevention of the formation of adhesions. The purpose of this study was to evaluate the validity of laparoscopy as a tool for the correction of malfunctioning PDCs and to introduce our specially designed technique.MethodsThe charts of 12 patients who underwent laparoscopic revisions of malfunctioning PDCs between May 1997 and June 2000 were reviewed for perioperative complications and long-term outcomes. We describe the causes of malfunction of PDCs and the laparoscopic technique for their revision.ResultsOf the 12 patients studied, the malfunction of eight catheters resulted from migration of the catheter into the upper abdomen. In 4 patients, formation of adhesion of either small bowel or omentum resulted in the malfunction of the PDC. The only complication we encountered was bleeding. It occurred in 3 patients, 1 of whom needed reoperation in order to achieve hemostasis. Over a median follow-up of 21 months all PDCs treated this way are functioning.ConclusionsThe laparoscopic management of malfunctioning PDCs is a valid option for the treatment of such a complication.

Postoperative complications of laparoscopic adjustable gastric banding

Background:  The primary aim was to determine the rate and nature of late postoperative complications in relation to the type of band used and the route through which it encircled the stomach in a retrospective review of postoperative complications that necessitated reoperation in 500 consecutive cases of laparoscopic adjustable gastric banding (LAGB) conducted over the past 48 months.

An unusual presentation of a huge seroma following ventral hernia repair

Background:  Seroma is a well‐known complication of postoperative ventral hernia (POVH) repair. It occurs during the immediate postoperative period and usually resolves with or without drainage within 4–6 weeks. The case presented herein is interesting in that a huge seroma appeared 6 months postoperatively. Ten litres were evacuated in each of two consecutive hospitalisations. The final outcome was a complete recovery with no mesh infection and no residual seroma. Of interest are the diagnosis and treatment of this unusual clinical presentation of seroma after POVH repair.

Laparoscopic repair of postbariatric incarcerated diaphragmatic hernia presenting as large bowel obstruction.

Laparoscopic repair of postbariatric incarcerated diaphragmatic hernia presenting as large bowel obstruction Moris Batumsky, M.D.*, Boris Yoffe, M.D., F.A.C.S., Oleg Dukhno, M.D. General and Vascular Surgery Department of Barzilai University Medical Center Affiliated with Ben Gurion University of Negev, Ashkelon, Israel Minimal Invasive and Bariatric Surgery Unit of Barzilai University Medical Center Affiliated with Ben Gurion University of Negev, Ashkelon, Israel Received September 26, 2014; accepted November 8, 2014