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1.
Obes Surg ; 16(12): 1669-74, 2006 Dec.
Article in English | MEDLINE | ID: mdl-17217645

ABSTRACT

Leakage and fistulization of the gastro-jejunostomy have been the major drawback of Roux-en-Y gastric bypass (RYGBP) surgery. Most authors agree that operative treatment is the mainstay of therapy in patients with signs of sepsis. However, intestinal contents causing localized infection may impede healing of sutured leaks in some patients, and fistulas develop. Because the anastomosis cannot be disconnected or exteriorized for anatomical reasons, other forms of treatment have to be applied. The following case-reports describe a technique with implantation of coated self-expanding stents. Leakage of the gastro-jejunostomy occurred in one patient 3 days after RYGBP and resulted in formation of a fistula. A fistula developed in a second patient 63 days after RYGBP. Coated self-extending stents were implanted endoscopically in both patients on postoperative days 19 and 67. Enteral nutrition could be started 6 days later. Stents were removed 2 months after implantation without problems. Weight loss and quality of life 7 and 21 months after stent removal have been excellent in both patients. Implantation of coated self-expanding stents was an effective and minimally invasive option for gastro-jejunal anastomotic fistulas after RYGBP where surgical repair was not possible. In these cases, application of stents allows septic source control without any other intervention.


Subject(s)
Gastric Bypass/adverse effects , Gastric Fistula/epidemiology , Gastric Fistula/etiology , Stents/adverse effects , Adult , Female , Gastric Fistula/surgery , Humans , Minimally Invasive Surgical Procedures/methods , Obesity, Morbid/surgery , Postoperative Complications , Treatment Outcome
2.
Obes Surg ; 15(1): 133-6, 2005 Jan.
Article in English | MEDLINE | ID: mdl-15760512

ABSTRACT

BACKGROUND: Although gastric bands are safe and effective devices, severe late complications may develop in rare cases. PATIENTS: 3 patients were treated for complete dysphagia after slippage of gastric bands. 2 of the patients were admitted for severe dehydration, 1 of whom developed cerebral venous infarction. Ischemia of the gastric pouch occurred in 1 patient. RESULTS: All 3 patients survived after successful medical therapy and surgical removal of the bands. Bariatric reoperations were performed in 2 patients (gastric sleeve resection, gastric bypass). CONCLUSION: Complete dysphagia on the basis of band slippage represents a life-threatening acute event, which may occur even years after implantation. Patients and doctors should be informed about this long-term risk of gastric banding.


Subject(s)
Equipment Failure , Gastric Bypass/adverse effects , Gastric Bypass/instrumentation , Laparoscopy/adverse effects , Obesity, Morbid/surgery , Postoperative Complications/surgery , Adult , Body Mass Index , Critical Illness , Female , Follow-Up Studies , Gastric Bypass/methods , Humans , Laparoscopy/methods , Middle Aged , Obesity, Morbid/diagnosis , Postoperative Complications/diagnosis , Reoperation , Risk Assessment , Severity of Illness Index , Treatment Outcome
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