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#December 2013
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Laparoscopic internal hernia repair after mini gastric bypass
Laparoscopic Roux-en-Y gastric bypass (LGBP) has been shown to be an effective treatment for morbid obesity, both in terms of weight loss and improvement in multiple comorbidities. While the laparoscopic approach offers many advantages to patients in terms of fewer wound complications, decreased length of hospital stay, and decreased postoperative pain, some complications of this operation continue to pose difficult clinical problems as the number of procedures performed increases. One such complication is internal hernia through one of the mesenteric defects, which can result in small bowel obstruction (SBO), ischemia, or infarction, and often requires emergency reoperation.
Internal hernias is a significant clinical problem, since it is the most common cause of small bowel obstruction after LGBP. Retrospective reviews have found the incidence of SBO after LGBP to be between 1.8 and 9.7%. The creation of a potential space as a result of weight loss may also be a contributing factor in the etiology of internal hernias, which often present in a delayed fashion. In addition, the particular case of pregnancy (with the mass effect of an enlarging uterus) may predispose to this condition.
An internal hernia can potentially occur through either two or three defects, depending on whether a retrocolic or antecolic technique is used for the Roux limb. Petersen’s defect is defined as the space between the Roux limb and the transverse mesocolon. A defect is also present between the biliopancreatic and Roux limbs at the jejunojejunostomy. If a retrocolic approach is used, a third defect in the transverse mesocolon is created. This is the most common site of internal hernia in most reports, which has prompted many surgeons to adopt an antecolic technique in order to rule out this defect.
G Sojod, L Marx, J Marescaux
Surgical intervention
5 years ago
1535 views
18 likes
0 comments
05:08
Laparoscopic internal hernia repair after mini gastric bypass
Laparoscopic Roux-en-Y gastric bypass (LGBP) has been shown to be an effective treatment for morbid obesity, both in terms of weight loss and improvement in multiple comorbidities. While the laparoscopic approach offers many advantages to patients in terms of fewer wound complications, decreased length of hospital stay, and decreased postoperative pain, some complications of this operation continue to pose difficult clinical problems as the number of procedures performed increases. One such complication is internal hernia through one of the mesenteric defects, which can result in small bowel obstruction (SBO), ischemia, or infarction, and often requires emergency reoperation.
Internal hernias is a significant clinical problem, since it is the most common cause of small bowel obstruction after LGBP. Retrospective reviews have found the incidence of SBO after LGBP to be between 1.8 and 9.7%. The creation of a potential space as a result of weight loss may also be a contributing factor in the etiology of internal hernias, which often present in a delayed fashion. In addition, the particular case of pregnancy (with the mass effect of an enlarging uterus) may predispose to this condition.
An internal hernia can potentially occur through either two or three defects, depending on whether a retrocolic or antecolic technique is used for the Roux limb. Petersen’s defect is defined as the space between the Roux limb and the transverse mesocolon. A defect is also present between the biliopancreatic and Roux limbs at the jejunojejunostomy. If a retrocolic approach is used, a third defect in the transverse mesocolon is created. This is the most common site of internal hernia in most reports, which has prompted many surgeons to adopt an antecolic technique in order to rule out this defect.
Laparoscopic sleeve gastrectomy for morbid obesity in a superobese woman
Laparoscopic sleeve gastrectomy has become a genuine morbid obesity procedure. Its frequency of use is quickly increasing as compared to other interventions. The rationale for such a success stems from the fact that the procedure is easy to perform, and weight loss is comparable to laparoscopic Roux-en-Y gastric bypass at least during the first three years. Its main immediate postoperative complication is the occurrence of fistula at the superior part of the cardia. Remotely, increased gastroesophageal reflux and strictures at the middle part of the stomach (at the incisura) can be observed. Although the technique seems easy, it should be performed in an extremely rigorous fashion to minimize complications. This video demonstrates the performance of a stepwise sleeve gastrectomy. Authors lay special emphasis on the entire steps which allow to reduce the risk of complications.
A Cardoso Ramos, M Galvao Neto
Surgical intervention
5 years ago
6213 views
81 likes
0 comments
19:26
Laparoscopic sleeve gastrectomy for morbid obesity in a superobese woman
Laparoscopic sleeve gastrectomy has become a genuine morbid obesity procedure. Its frequency of use is quickly increasing as compared to other interventions. The rationale for such a success stems from the fact that the procedure is easy to perform, and weight loss is comparable to laparoscopic Roux-en-Y gastric bypass at least during the first three years. Its main immediate postoperative complication is the occurrence of fistula at the superior part of the cardia. Remotely, increased gastroesophageal reflux and strictures at the middle part of the stomach (at the incisura) can be observed. Although the technique seems easy, it should be performed in an extremely rigorous fashion to minimize complications. This video demonstrates the performance of a stepwise sleeve gastrectomy. Authors lay special emphasis on the entire steps which allow to reduce the risk of complications.
Laparoscopic excision of a cesarean section scar
We present the case of a 33-year-old G1P1 patient who was adressed to our hospital for intermenstrual bleeding and pain. The patient had a C-section approximately 2 years earlier, and wanted to have another pregnancy.
In the diagnostic work-up, ultrasonography showed a retroverted uterus with an image of a C-section scar niche, that had a 2mm thick remaining myometrium. A further hysteroscopic examination did not reveal bleeding lesions in the uterine cavity, but the cesarean scar was hyperemic and hemorrhagic, and had a non-absorbable suture.
Taking into account the presence of non-absorbable suture material and the very thin remaining myometrium in a patient with a desire for another pregnancy, the decision was made to excise the pathologic scar, which was performed laparoscopically with a two-layered closure of the defect. At 3 months of follow-up, the patient was asymptomatic. Ultrasonographically, a niche image could be seen, with a 6mm thick myometrium.
II Ion, A Harbada
Surgical intervention
5 years ago
1943 views
26 likes
0 comments
09:05
Laparoscopic excision of a cesarean section scar
We present the case of a 33-year-old G1P1 patient who was adressed to our hospital for intermenstrual bleeding and pain. The patient had a C-section approximately 2 years earlier, and wanted to have another pregnancy.
In the diagnostic work-up, ultrasonography showed a retroverted uterus with an image of a C-section scar niche, that had a 2mm thick remaining myometrium. A further hysteroscopic examination did not reveal bleeding lesions in the uterine cavity, but the cesarean scar was hyperemic and hemorrhagic, and had a non-absorbable suture.
Taking into account the presence of non-absorbable suture material and the very thin remaining myometrium in a patient with a desire for another pregnancy, the decision was made to excise the pathologic scar, which was performed laparoscopically with a two-layered closure of the defect. At 3 months of follow-up, the patient was asymptomatic. Ultrasonographically, a niche image could be seen, with a 6mm thick myometrium.