Sergio Carandina

Two-step conversion surgery after failed laparoscopic adjustable gastric banding. Comparison between laparoscopic Roux-en-Y gastric bypass and laparoscopic gastric sleeve

BACKGROUND Despite its worldwide popularity, laparoscopic adjustable gastric banding (LAGB) requires revisional surgery for failures or complications, in 20-60% of cases. The purpose of this study was to compare in terms of efficacy and safety, the conversion of failed LAGB to laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy. (LSG). METHODS The bariatric database of our institution was reviewed to identify patients who had undergone conversion of failed LAGB to LRYGB or to LSG, from November 2007 to June 2012. RESULTS A total of 108 patients were included. Of these, 74 (68.5%) underwent conversion to LRYGB and 34 to LSG. All of the procedures were performed in 2-stage and laparoscopically. The mean follow-up for the LRYGB group was 29.1±17.9 months while for the LSG patients was 24.2±14.3 months. The mean body mass index (BMI) prior LRYGB and LSG was 45.6±7.8 and 47.5±5.6 (P = .09), respectively. Postoperative complications occurred in 16.2% of the LRYGB patients and in 2.9% of the LSG group (P = .04). Mean percentage of excess weight loss was 59.9%±16.2% and 70.2%±16.7% in LRYGB, and it was 52.2%±11.4% and 59.9%±14.4% in LSG at 12 months (P = .007) and 24 months (P = .01) after conversion. CONCLUSION In this series, LRYGB and LSG are both effective and adequate revisional procedure after failure of LAGB. While LRYGB seems to ensure greater weight loss at 24 months follow-up, LSG is associated with a lower postoperative morbidity.

Petersen’s internal hernia complicating a laparoscopic omega loop gastric bypass

Petersen’s internal hernia complicating a laparoscopic omega loop gastric bypass Laurent Genser, M.D.*, Sergio Carandina, M.D., Antoine Soprani, M.D. Department of Digestive and Hepato-Pancreato-Biliary Surgery, Assistance Publique-Hopitaux de Paris (AP-HP), Pitie-Salpetriere University Hospital, Pierre & Marie Curie University, Paris, France Department of Digestive and Metabolic Surgery, Jean Verdier Hospital, Centre Integre Nord Francilien de la prise en charge de l’Obesite (CINFO), Universite Paris XIII-UFR SMBH “Leonard de Vinci,” AP-HP, Bondy, France Department of Digestive Surgery, Clinique Geoffroy-Saint Hilaire, Paris, 75005, France Received April 26, 2015; accepted May 3, 2015

Laparoscopic sleeve gastrectomy after failed gastric banding: is it really effective? Six years of follow-up

BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has become a valuable surgical option to rescue laparoscopic adjustable gastric banding (LAGB) failures. OBJECTIVES The aim of this study was to determine whether conversion to LSG after failed LAGB (CLSG) is a well-tolerated and effective rescue procedure compared with primary LSG (PLSG) in the long term. SETTING University hospital, France. METHODS A retrospective review of data concerning consecutive patients receiving a LSG between February 2008 and December 2014 was conducted. Mortality, postoperative complications, and weight loss outcomes were analyzed. RESULTS Of 701 LSG, 601 (85.7%) were PLSG and 100 (14.3%) were CLSG. The mortality rate was 0%. Overall morbidity was comparable between the primary and conversion group (10% versus 6%, P = .27). The mean percentage of excess weight loss at 3, 36, and 72 months was 34.9%, 72.1%, and 57.2% after PLSG and 22.6%, 51.2% and 29.8% after CLSG (P<.05). The failure rate (mean percentage of excess weight loss<50%) was higher in the CLSG group during the first 5 postoperative years (P < .001) with more than two thirds of the CLSG considered as having failed at 60 months. Patients who underwent band ablation as a result of insufficient weight loss or weight regain presented the worst results after conversion to LSG. CONCLUSION In this study, the conversion of failed LAGB to LSG in 2 steps indicated a safety profile comparable to that of primary LSG but was significantly less effective from the early postoperative course (3 mo) up to 6 years postoperatively. CLSG may not be the best option because a third operation may be needed as a result of insufficient weight loss.

Additional tools to improve the follow up after bariatric surgery

Bariatric surgery has proved its efficiency versus medical treatment when referring to long-term results [1]. Despite technical advancements in bariatric surgery that have improved the patient’s safety the last decade, there are still many limitations and deficiencies in the standard of care for patients with morbid obesity. Barriers to providing quality healthcare include the slow acknowledgment among practitioners that obesity requires long-term management; inadequate physician training in nutrition and obesity; limited reimbursement for the full range of treatments and wide variety in different countries; general misperception of increased cost of bariatric surgery; and limited referral of patients with severe obesity to experienced surgeons, even though bariatric surgery is a level A health-improving treatment option (i.e., with improvement based on data from multiple randomized trials or meta-analyses) [2]. The current letter approaches 2 main deficiencies in our daily practice (insufficient preoperative evaluation and follow-up) and proposes an innovative idea to perfect our activity, increasing patients’ satisfaction and improving the long-term results. The first problem we discuss is insufficient preoperative evaluation. All accredited bariatric centers have a multidisciplinary approach, with nutritional, psychological, and endocrinology support, but only few have additional tools like support groups or different workshops for the patients (i.e., cooking, self-affirmation, hypnosis, reading food labels) with the aim to enhance patients’ involvement and determination. The second is represented by the patient’s adherence to a bariatric program. “Why has bariatric surgery failed?” has

Revision of Lap-Band to MGB

Adjustable gastric banding was a common restrictive bariatric operation in the 1990s and early 2000s. Being a relatively simple procedure, it led the bariatric operations into laparoscopic technique.

Which is the correlation between carcinoid tumor and Laparoscopic Sleeve Gastrectomy? A case series and literature review

Introduction Gastric Carcinoid Tumors (GCT) are very rare in general population, but some studies evidenced a higher incidence among bariatric surgery patients. Laparoscopic Sleeve Gastrectomy (LSG) is a widely accepted procedure for the surgical treatment of morbid obesity. LSG acts both in reducing food intake and interfering with hormonal balance in the gut-brain axis. In these patients, incidental GCT diagnosis can occur both during pre-bariatric surgery investigation and during post-operative follow-up. Methods We retrospectively analyzed the database of obesity patients submitted to LSG in two different centers to find out incidence of GCT in patients treated by surgery from May 2013 to March 2018. Results From the 560 obese consecutive patients underwent LSG, we recorded two cases of patients with GCT (0.36%): the case 1 was a patient who had a pre-operative diagnosis of GTC receiving a curative LSG which totally included the carcinoid in the resected portion; the case 2 was a patient that received a curative endoscopic resection 42 months after LSG. Discussion the predisposing factors that can correlate GCT with obesity and LSG and in particular the hormonal changes have been discussed. We illustrated our experience about the management of these tumors in obese patients. Conclusion there are neither certain data which evidence a correlation between obesity and GCT, nor data to support the hypothesis of a higher incidence of GCT after bariatric surgery. Based on our experience in obese patients the finding of GCT in the pre-operatory phase is not an absolute contraindication for bariatric surgery.

Resolution of type 2 diabetes after sleeve gastrectomy: a 2-step hypothesis

BACKGROUND Weight loss (WL) and altered gut hormonal levels are involved in glucose homeostasis after laparoscopic sleeve gastrectomy (LSG). OBJECTIVES The aim of this study was to evaluate the time-related effects of WL, ghrelin, and glucacon-like peptide-1 (GLP-1) plasma concentrations on type 2 diabetes resolution after LSG. SETTING University hospital, Italy. METHODS Ninety-one patients who underwent LSG were investigated. Insulin secretion (insulinogenic index [IGI]), insulin resistance, plasma glucose level and percentage glycated hemoglobin using the oral glucose tolerance test were assessed before surgery, on postoperative day 3, and then at 6, 12, 24, and 36 months after LSG. At the same time points, WL, ghrelin, and GLP-1 levels were determined. RESULTS During follow-up, the resolution rate of type 2 diabetes was 9.4%, 42.3%, 71.8%, 81.2%, and 91.8%, respectively. Ghrelin plasma concentrations decreased significantly after LSG (271.5 ± 24.5 pg/mL versus 122.4 ± 23.4 pg/mL, P = .04). GLP-1 plasma concentrations increased significantly after LSG (1.7 ± 2.6 pg/mL versus 2.5 ± 3.4 pg/mL, P = .04). The percentage of excess weight loss and IGI presented a positive linear correlation (r) at all follow-up time points with a strong positive correlation at 12 and 24 months. A strong negative correlation between ghrelin and IGI was recorded during the first 3 days after LSG (r = -.9). GLP-1 and IGI presented a strong positive correlation at day 3 and 6 months (i.e., .8 and .8, respectively). CONCLUSION LSG may affect glucose homeostasis by 2 different time-related modes: a first step in which the hormonal changes play a predominant role in glucose homeostasis and a second step in which the percentage excess weight loss determines the metabolic results.

Left colon cancer presenting as fecopneumothorax: a case report and review of literature

Atraumatic colopleural fistula (CPF) is an unusual complication of intra-abdominal disease with only very few cases reported in the literature so far. Diverticulitis, inflammatory bowel disease, and advanced colon cancer as presented in our case have been incriminated as the underlying abdominal disease leading to this life-threatening complication [1–4]. Fecopneumothorax occurring as a result of the CPF complicating a colon cancer is extremely rare, and very few reports exist in the literature [4]. We present herein a case of an 80year-old male with fecopneumothorax as a result of CPF complicating a splenic flexure colon cancer.

Laparoscopic Removal of Giant Gossypiboma

Background: The term gossypiboma denotes a mass of cotton that is accidentally retained in the body postoperatively. Case Report: Our case describes a 40-year-old female patient with a giant abdominal mass that occurred 9 years after a cesarean section delivery. Computed tomography scan and magnetic resonance imaging showed a 20-cm mass. A laparoscopic retrieval was performed with the placement of trocars on the previous Pfannenstiel incision scar. The patient was discharged 48 hours after surgery without complications. Discussion: Gossypibomas are not rare, are often asymptomatic, and can be laparoscopically treated. To date, the literature has described different cases and stressed retention time and size as being limitations of laparoscopic retrieval. Conclusion: To our knowledge, this is the first case of giant gossypiboma treated by laparoscopic suprapubic access. This approach permitted a reduction in complication rates, a shorter hospitalization time, and more satisfactory cosmetic results.

Small bowel obstruction secondary to gastric banding migration.

– see /10.10 ence: Surge itals aris, io.car In developed countries, morbid obesity is a rising health problem that is reaching epidemic proportion. The only long-term effective treatment is surgical operation. For that reason, in the past years, various surgical procedures have been developed for the treatment of obesity, including the gastric bypass, biliopancreatic diversion, vertical banded gastroplasty, isolated sleeve gastrectomy, and adjustable gastric banding. Laparoscopic gastric banding (LGB) has become the most popular restrictive procedure in Europe because of its minimal invasiveness, complete reversibility, and low morbidity and mortality rates [1–3]. We report a rare and late complication of gastric banding: acute bowel obstruction resulting from migration of gastric band occurring 8 years after its placement.