Endoscopic treatment of leaks after laparoscopic sleeve gastrectomy using MEGA esophageal covered stents.

BACKGROUND: Sleeve gastrectomy has become one of the main bariatric procedures over the last few years. This can be explained by the relative simplicity and high effectiveness of this method. Yet, it causes complications as any other method. Staple line leaks are the most frequent ones. According to different sources, this complication may occur with 0-7% frequency. Until 2013, surgery was the only effective treatment method for this complication. However, reoperations considerably increased treatment cost and patient morbidity. The aim of this study is to present the possibilities of endoscopic treatment of leaks after laparoscopic sleeve gastrectomy. METHODS: From 2014 to 2016 14, cases of leaks following sleeve gastrectomy were diagnosed in our Department in Lódz. All of them were treated with MEGA stent in order to cover the leak site. Due to severe peritonitis, 3 patients had to undergo surgery prior to implantation of the prosthesis. Another patient underwent an unsuccessful attempt of leak closing via OTSC method prior to implantation of the prosthesis. Patients were nourished from the 3rd day after the surgery. On average, prostheses were removed on the 34th day after the implantation. RESULTS: The leak was fully sealed in 13 out of 14 cases. In 10 cases the leak was fully healed. There were 2 cases of patients' deaths: the result of a multi-organ failure in one case and early esophageal perforation in the other one. The overall success rate was 90.9%. CONCLUSION: Sealing leaks occurring after sleeve gastrectomy with MEGA stents represent an effective method and should become the technique of choice.

Slippage-a Significant Problem Following Gastric Banding-a Single Centre Experience.

BACKGROUND: Laparoscopic adjustable gastric banding is a well-established method of morbid obesity treatment. One of the complications is slippage. AIM: The aim of the study was to assess the prevalence, causes, and handling of slippage after LAGB in own material. MATERIAL AND METHODS: There were 740 procedures performed by one surgical team. The patients were selected according to the IFSO principles. The pars flaccida technique was applied and the position of the band was controlled. There was neither plication nor the bands were sutured to the stomach wall. Slippage was recognized during X-ray examination. With these patients, the band was emptied of liquid, gastric endoscopy was performed routinely, and patients were qualified for surgery. RESULTS: The patient group consisted of 500 women and 240 men. The average body weight was 128 kg and BMI 44.60 kg/m2. The slippage was observed in 8.1% cases in 7.03% patients. In 1.08%, slippage occurred twice. The main problems reported by patients were pain, a significant increase of disposable food intake, vomiting, and weight gain. In a small group of patients, these complications were detected incidentally. All patients were treated surgically. In 38.33%, the band repositioning was performed. In 33.33%, a different surgical approach was performed. In the group of reoperated patients, there were no fatal cases or any severe complications. CONCLUSIONS: In conclusion, we believe that slippage is and will continue to be a significant problem in patients with gastric banding. Patient education focused on dietary errors may reduce the incidence of this complication. The grace period between the primary surgery and the redo operation should be applied regarding reoperation.

Laparoscopic Adjustable Gastric Band (LAGB) Migration - Endoscopic Treatment Modalities.

Laparoscopic adjustible gastric binding (LAGB) is one of most common surgical methods of treating obesity. Gastric band migration (erosion) is a typical LAGB complication, with a frequency of about 1-4%. The aim of the study was to present the possibilities of endoscopic diagnosis and treatment of this complication. MATERIAL AND METHODS: The study was carried out in the Department of Gastroenterological, Oncological and General Surgery in Lódz. Between 2008 and 2015, 450 gastric bands were implanted using the laparoscopic technique in 318 (71%) women and 132 (29%) men. In this period 7 cases of band migration were diagnosed - 3 cases in men (2.3%) and 4 cases in women (1.3%), what presents 1.56% of general number of complications. Five out of 7 eroded bands were qualified for endoscopic removal. Four out of 5 qualified eroded bands were removed using the gastric band cutting technique. In one case we used the musculo-mucosal incision technique. In order to diagnose early perforations all patients underwent control passage examinations with oral contrast (gastrografin) 3-6 hours after the procedure. RESULTS: All 5 out of 5 qualified eroded gastric bands were successfully removed with the endoscopic method, which gives 100% success rate in own material. Two endoscopic methods were used: 1) endoscopic gastric band cutting, 2) endoscopic musculo-mucosal incision. CONCLUSIONS: Endoscopy gives a possibility of instant diagnosis of gastric band migration and early minimally invasive treatment. One of our endoscopic methods of removing the bands by making several incisions of the musculo-mucosal plicae has not yet been described in professional medical literature.

Laparoscopic sleeve gastrectomy - 7 years of own experience.

INTRODUCTION: Laparoscopic sleeve gastrectomy is a procedure frequently chosen by patients and surgeons that carries the risk of serious complications that are difficult to treat. AIM: To describe the operations performed by us, considering complications and their management. MATERIAL AND METHODS: We performed 565 laparoscopic sleeve gastrectomies. Standard surgical technique was used. A 34 Fr calibration tube was used. An additional reinforcing suture was applied over the staple line. RESULTS: There was no need for conversion. In 7.79% of patients, infarcts of the posterior pole of the spleen were observed, whereas 8 patients (1.42%) developed gastric fistulas in the His angle region. In 3 cases, it led to development of an abscess in the posterior splenic pole region and 2 of these developed secondary gastric fistulas of typical location. In total, there were 5 deaths among the patients who had been operated on - 3 due to septic complications in the course of fistula, 1 due to encephalopathy and 1 as a result of myocardial infarction. CONCLUSIONS: Sleeve gastrectomy is an effective and safe method of obesity treatment. The causes of the most severe complication - gastric fistula - cannot be established unequivocally. Infarcts of the posterior pole of the spleen, as a potential cause of fistulas, deserve particular attention. In our opinion, primary closure of the fistula by suturing is an inappropriate method of management, whereas the best results are obtained with temporary gastrointestinal tract prosthesis.

Own experience improving port implantation in laparoscopic adjustable gastric banding.

INTRODUCTION: Laparoscopic adjustable gastric banding (LAGB) is a method frequently used for treating obesity. It requires periodic band regulation associated with the need for port puncture. However, there is always a substantial risk of port rotation. AIM: This publication presents a solution of the problem for a MiniMizer Extra band. MATERIAL AND METHODS: One thousand one hundred and twenty-four individuals were operated on for obesity in the Department of Gastroenterological, Oncological and General Surgery of the Medical University of Lodz between 2005 and 2009. In 637 patients LAGB was performed. These LAGB patients were divided into three groups. In group I (20 patients) MiniMizer Extra bands were placed without port stabilization. In the second group (292 patients) MiniMizer Extra band placement with port stabilization was commenced. In the third group (325 patients) bands of other manufacturers (AMI, Inamed, Midband, Obtech) were used without port stabilization. The port was implanted into the subcutaneous tissue in the left subcostal region, medial to the left working tool trocar position. RESULTS: Port rotation was observed on the very first band adjustment in 3 (0.92%) and 11 (55%) patients with a band other than MiniMizer Extra (n = 325) and the first 20 patients with a MiniMizer Extra band. A different technique of port stabilization was applied in a further 292 patients on MiniMizer Extra band placement and no port rotation was noted. CONCLUSIONS: We believe that MiniMizer additional port stabilization is necessary for its frequent rotation. Simultaneously, application of our method is easy, does not prolong the procedure significantly and secures comfortable access to the port.

Gastric cancer after laparoscopic adjustable gastric banding: case report.

Gastric cancer in patients who have undergone bariatric surgery is rare. The authors present a case of stomach cancer in a patient 6 years after adjustable silicone gastric band placement. The tumour was located below the band, not in its direct vicinity. Aetiological and risk factors of stomach cancer incidence in obese patients are discussed in this case study.