Mesenteric Torsion as a Cause of Late Abdominal Pain after Gastric Bypass Surgery.

Gastric bypass (GBP) has been the most common surgical way to treat obesity and its comorbidities. Late abdominal pain may occur by gastro-jejunal ulcers, gallstones, internal herniation or, rarely, intussusception. In an area with more than 1000 GBPs performed yearly, three patients with primary small bowel volvulus causing abdominal pain and requiring emergency or semi-urgent surgery were identified. Patients' histories, radiology, and surgery performed are presented. Weight loss followed by mesenteric narrowing of the root and thus relative elongation may make rotation of the small bowel mesentery possible. Such a torsion might be an overlooked differential diagnosis in obscure abdominal pain after GBP.

Bariatric surgery in a national cohort of women: sociodemographics and obstetric outcomes.

OBJECTIVE: In a large, prospective Swedish national cohort, we investigated individual birth characteristics for women who had undergone bariatric surgery and their obstetric outcome and made comparisons with all other women during the same period. STUDY DESIGN: The cohort consisted of 494,692 women born 1973-1983 of which 681 women who had undergone bariatric surgery constituted the index group. RESULTS: The index women more often have parents with lower sociodemographic status and are more often born large for gestational age. The women surgically treated before their first child had a shorter gestational length, their children had lower birthweight, and were more often born small for gestational age compared with the children born to the reference mothers. Women whose child was born before their bariatric surgery more often had a cesarean section, and their children were more often large for gestational age. CONCLUSION: Preconception bariatric surgery in obese women may be associated with improved obstetric outcomes.

Pelvic exenteration for advanced and recurrent malignancy.

BACKGROUND: Improved surgical techniques and oncological treatment render many advanced pelvic tumors amenable to curative resection. We evaluated morbidity, survival, and quality of life (QoL) after extended pelvic procedures. METHODS: From January 2003 to November 2008, 85 patients underwent multivisceral pelvic resection; 87% had colorectal or anal malignancies. Preoperatively, endoscopy and imaging procedures were performed, followed by multidisciplinary assessment. Fifty-eight percent received preoperative chemotherapy and pelvic irradiation. Exenteration was total in 32 patients and posterior in 48. Five posterior resections included partial cystectomy and 21 encompassed resection of the bony pelvis. Myocutaneous flaps were used for reconstruction in 33 cases. Urinary diversion was achieved by ileal conduit in 24 and by continent pouch in 8. QoL was evaluated prospectively in 22 late cases. RESULTS: All patients were evaluated. Clear margins were obtained in 66%. Median duration of surgery was 680 (310-1,320) min, and blood loss was 1,800 (350-19,000) ml. Morbidity was 68%, whereof major complications constituted 13%. Median hospital stay was 18 (5-70) days. There was no 90-day mortality. Median follow-up was 24 (3-71) months. Local control was obtained in 77 patients. Twenty-seven manifested disseminated disease without local recurrence, two developed isolated local recurrence, and six had local and systemic recurrences. Twenty-one died after a median of 11 (4-55) months follow-up. Survival was correlated with clear margins and time to relapse. QoL was improved at 16 months after surgery. CONCLUSIONS: Multivisceral pelvic surgery is possible with acceptable morbidity and QoL. Thorough patient selection and multimodal therapy are necessary to attain maximum benefit.