Sheetal Patel

Reasons and outcomes of reoperative bariatric surgery for failed and complicated procedures (excluding adjustable gastric banding).

BackgroundThe rise of bariatric surgery has lead to an increasing number of reoperations for failed bariatric procedures. The reasons and types of these operations are varied in nature and remain to be defined.MethodsA retrospective review of a prospectively collected database was conducted to identify patients who underwent laparoscopic revisional surgery for non-gastric banding-related bariatric procedures between 2001 and 2008.ResultsOf 384 secondary bariatric operations, 151 reoperative procedures were performed. Twenty-six vertical banded gastroplasties (17.2%), 2 mini-gastric bypasses (1.3%), 2 non-divided bypasses (1.3%), 1 distal Roux-en-Y gastric bypass (RYGBP; 0.7%), and 2 sleeve gastrectomies (1.3%) were converted to RYGBP. Three RYGBP (2%) and four jejunoileal bypass procedures (2.6%) were reversed secondary to malnutrition. One jejunoileal bypass (0.7%) and one biliopancreatic diversion (0.7%) underwent sleeve gastrectomies. Three pre-anastomotic rings were removed due to erosion (2%). Eleven pouch trimmings (7.3%), 16 redo gastrojejunostomies (10.6%), 5 redo jejunojejunostomies (3.3%), 36 remnant gastrectomies (23.8%), and 2 gastrogastric fistula takedowns (1.3%) were performed for pouch enlargements, strictures, and gastrogastric fistulas. Thirty-six patients (23.8%) underwent a combination of these procedures. The major morbidity (13.2%) was related to leaks. Other complications included wound infection, intra-abdominal abscess formation, and trocar site hernias. The mortality rate was 2%.ConclusionsReoperative bariatric surgery is a complex and growing field in bariatric surgery. The indications for surgical reoperation can vary depending on the procedure and reason for intervention. Laparoscopy appears to be a feasible approach. Though safe, morbidity and mortality are significantly higher than in primary bariatric procedures.

Reasons and outcomes of laparoscopic revisional surgery after laparoscopic adjustable gastric banding for morbid obesity.

BACKGROUND Laparoscopic adjustable gastric banding (LAGB) is a purely restrictive procedure that has been proved to be an effective tool in achieving weight loss. The low operative morbidity and reversibility are often seen as advantages of this procedure compared with other bariatric approaches. We have attempted to define the reasons for revisional surgery after LAGB and the outcomes. METHODS A retrospective review of a prospectively maintained database was performed from February 2001 to October 2008 at a center of excellence after institutional review board approval. The patients who had undergone revisional surgery after primary LAGB were evaluated. RESULTS Of 343 patients who had undergone primary LAGB, 60 subsequently underwent a revisional procedure. In addition, 28 revisional procedures were performed on patients who had undergone primary LAGB at an outside institution. These procedures included 39 (44.3%) band removals alone, 12 (13.6%) band removals with conversion to sleeve gastrectomy, 13 (14.8%) band removals with conversion to Roux-en-Y gastric bypass, 9 (10.2%) band repositioning, and 2 (2.3%) band replacements. In addition, 13 (14.8%) port-related procedures (3 relocations, 6 reconnections, and 4 replacements/removals) were performed. CONCLUSION Although reversible and efficacious, LAGB appears to have a high incidence of complications requiring revisional surgery and/or band removal. The results of our study have shown that laparoscopic revisional surgery after primary LAGB is safe and can be performed with minimal morbidity.

Laparoscopic Roux-en-Y duodenojejunal bypass for superior mesenteric artery syndrome: case reports and review of the literature.

Introduction: Superior mesenteric artery syndrome is a clearly defined and uncommon medical condition. Surgical intervention is needed for failed long-term medical management. Material and Methods: We report a series of 3 cases, a 17-year-old woman, a 23-year-old man, and a 50-year-old woman that were successfully treated by Roux-en-Y duodenojejunal bypass using a laparoscopic approach. Technique: A 5-trocar laparoscopic approach was used for the surgery. A 75 cm long Roux limb was used in all cases. Results: The postoperative period was unremarkable and symptoms of obstruction subsided in all 3 cases. Conclusions: Laparoscopic duodenojejunal bypass seems to be a feasible and safe treatment option for superior mesenteric artery syndrome.