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Focus On Bariatric Surgery!

Epublication, Jun 2015;15(06). URL: http://websurg.com/doi/fc01en15
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Laparoscopic Roux-en-Y gastric bypass: live demonstration and technical details
Roux-en-Y gastric bypass (RYGB) has become a common procedure for the management of morbid obesity. However, learning to perform such a procedure may be difficult as it is made up of very technical operative steps in complex cases of overweight patients with a great amount of adipose tissue. In order to prevent complications, an operative strategy should be adopted, allowing for an easy and rapid acquisition of the technique. Each step is perfectly mastered and outlined.
This video demonstrates a laparoscopic Roux-en-Y gastric bypass performed live, showing all the preoperative and operative patient settings. The surgical technique is thoroughly explained.
M Vix, M Nedelcu, HA Mercoli, D Mutter, J Marescaux
Surgical intervention
3 years ago
6894 views
191 likes
0 comments
28:09
Laparoscopic Roux-en-Y gastric bypass: live demonstration and technical details
Roux-en-Y gastric bypass (RYGB) has become a common procedure for the management of morbid obesity. However, learning to perform such a procedure may be difficult as it is made up of very technical operative steps in complex cases of overweight patients with a great amount of adipose tissue. In order to prevent complications, an operative strategy should be adopted, allowing for an easy and rapid acquisition of the technique. Each step is perfectly mastered and outlined.
This video demonstrates a laparoscopic Roux-en-Y gastric bypass performed live, showing all the preoperative and operative patient settings. The surgical technique is thoroughly explained.
Robot-assisted Roux-en-Y gastric bypass after band removal
Patients ask for a new weight loss surgical procedure after gastric band removal due to a lack of efficiency or to complications. Although gastric banding is a reversible procedure, perigastric adhesions located mostly in the upper part of the stomach can make new approaches to this area difficult.
We report the case of a woman who benefited from a gastric banding in 2006. This gastric band was removed in 2010. The patient developed a left subphrenic abscess, which was drained under CT-scan control postoperatively.
Two years after this procedure, the patient wishes to benefit from a new weight loss surgical procedure as she gained 10Kg since her gastric band removal. She has a BMI of 40 and presents with respiratory and rheumatological co-morbidities.
The preoperative work-up was uneventful, and this is particularly true for the esogastroduodenal contrast exam and the gastroscopy.
During the procedure, multiple omental parietal adhesions were found, as well as tight adhesions between the liver, the stomach, and the left crus.
Dissecting the stomach using a conventional approach was made difficult by the presence of these adhesions, and we had to perform an upper pole gastrectomy of the greater curvature in order to clearly identify the gastroesophageal junction’s anatomy. A complete dissection of the left subcardial area is necessary in order to prevent the formation of an excessively large gastric pouch, which could lead to a regain in weight.
This video covers the whole procedure in detail and highlights dissection challenges, which can occur in patients who had their gastric band removed.
The postoperative outcome was uneventful in this woman, with a significant weight loss at one year.
M Vix, D Mutter, J Marescaux
Surgical intervention
3 years ago
1332 views
46 likes
0 comments
25:55
Robot-assisted Roux-en-Y gastric bypass after band removal
Patients ask for a new weight loss surgical procedure after gastric band removal due to a lack of efficiency or to complications. Although gastric banding is a reversible procedure, perigastric adhesions located mostly in the upper part of the stomach can make new approaches to this area difficult.
We report the case of a woman who benefited from a gastric banding in 2006. This gastric band was removed in 2010. The patient developed a left subphrenic abscess, which was drained under CT-scan control postoperatively.
Two years after this procedure, the patient wishes to benefit from a new weight loss surgical procedure as she gained 10Kg since her gastric band removal. She has a BMI of 40 and presents with respiratory and rheumatological co-morbidities.
The preoperative work-up was uneventful, and this is particularly true for the esogastroduodenal contrast exam and the gastroscopy.
During the procedure, multiple omental parietal adhesions were found, as well as tight adhesions between the liver, the stomach, and the left crus.
Dissecting the stomach using a conventional approach was made difficult by the presence of these adhesions, and we had to perform an upper pole gastrectomy of the greater curvature in order to clearly identify the gastroesophageal junction’s anatomy. A complete dissection of the left subcardial area is necessary in order to prevent the formation of an excessively large gastric pouch, which could lead to a regain in weight.
This video covers the whole procedure in detail and highlights dissection challenges, which can occur in patients who had their gastric band removed.
The postoperative outcome was uneventful in this woman, with a significant weight loss at one year.
Robot-assisted gastric band removal
Adjustable gastric banding (AGB) is one of the surgical treatment modalities for morbid obesity. Over the years, popularity for this treatment increased. It has been by far the most performed bariatric procedure for years in Europe and in the United States. Many gastric band removals are linked to complications and weight loss failure, indicating a new bariatric procedure for some of the patients. Complications after AGB are not uncommon and consist mainly of gastroesophageal reflux disease, pouch dilatation, slippage of the band, and intragastric migration. The failure of the gastric band is multifactorial. Gastric band removal does not preclude a new bariatric procedure (the most common procedure performed in our department is Roux en-Y gastric bypass), which is feasible in the same operative time but the 2-step approach is suitable. The new bariatric procedure offers adequate surgical outcomes and satisfactory results in terms of weight loss.
M Nedelcu, A D'Urso, HA Mercoli, M Vix, D Mutter, J Marescaux
Surgical intervention
3 years ago
1027 views
36 likes
0 comments
08:14
Robot-assisted gastric band removal
Adjustable gastric banding (AGB) is one of the surgical treatment modalities for morbid obesity. Over the years, popularity for this treatment increased. It has been by far the most performed bariatric procedure for years in Europe and in the United States. Many gastric band removals are linked to complications and weight loss failure, indicating a new bariatric procedure for some of the patients. Complications after AGB are not uncommon and consist mainly of gastroesophageal reflux disease, pouch dilatation, slippage of the band, and intragastric migration. The failure of the gastric band is multifactorial. Gastric band removal does not preclude a new bariatric procedure (the most common procedure performed in our department is Roux en-Y gastric bypass), which is feasible in the same operative time but the 2-step approach is suitable. The new bariatric procedure offers adequate surgical outcomes and satisfactory results in terms of weight loss.