Mechanical ileus induces surgical intervention due to gastric balloon: a case report and review of the literature.

A temporary non-surgical approach for treatment of obesity is the gastric balloon that serves as an alternative procedure for many patients with frustrated diet attempts. Deflation and displacement of the balloon resulting in acute intestinal obstruction and subsequent surgical intervention is a rare complication. A BioEnterics Intragastric Balloon was endoscopically implanted in a 35-year-old female with a body mass index (BMI) of 28 kg/m(2). The procedure succeeded without complications, and weight loss was effective during the first 6 months. One year after balloon implantation, the patient presented with abdominal cramps and vomiting due to ileal obstruction. Since endoscopic efforts to remove the deflated and displaced balloon failed, emergency laparotomy and enterotomy were necessary. Vascularization of the dilated small bowel was compromised, but recovered after decompression. Patients' postoperative course was uneventful. The gastric balloon model can be associated with major complications and should be used critically. Removal of the balloon should be assured not later than 6 months when weight loss decreases.

Endovascular treatment of venous graft stenosis in the inferior vena cava and the left hepatic vein after complex liver tumor resection.

Endovascular treatment has been reported for a variety of conditions that result in venous obstruction in the iliocaval territory. The present report describes a patient who underwent a complex resection of a tumor that infiltrated the retrohepatic segment of the inferior vena cava (IVC), necessitating replacement of the IVC with a polytetrafluoroethylene (PTFE) graft. Postoperatively, symptomatic venous obstruction occurred in the graft and the left hepatic vein. Treatment required stent placement bridging native veins and the graft. The patient underwent placement of a self-expanding stent within the IVC and the PTFE graft with treatment of the hepatic vein stenosis via jugular vein access.

Cholecystokinin-58 is more potent in inhibiting food intake than cholecystokinin-8 in rats.

INTRODUCTION: Several cholecystokinin (CCK) forms have been detected in plasma, but most studies on food intake investigated the effects of CCK-8 only. Recently, it has been demonstrated that CCK-58 is the only endocrine-active form of CCK in rats. METHODS: CCK-58 was synthesized with a peptide synthesizer using FMOC chemistry and CCK-58 effects on food intake were compared to CCK-8 in rats. RESULTS: Both CCK-58 and CCK-8 inhibited food intake in a dose-dependent manner and were equally potent at 30 min. CCK-58 showed a prolonged inhibition of food intake compared to CCK8 at the higher dose tested (7 nmol/kg), inhibiting food intake also at 60 min, and cumulative food intake was inhibited for up to 210 min by CCK-58. CONCLUSIONS: CCK-58 has the same potency in inhibiting food intake as CCK-8 in rats, but inhibits food intake longer. This might be due to its tertiary structure resulting in a delayed plasma degradation or a prolonged binding at the CCK receptor. As CCK-58 is the major CCK form in the gut wall and possibly in the circulating blood in humans, the effects of CCK on food intake might have been underestimated in the past.

Laparoscopic sleeve gastrectomy: standardized technique of a potential stand-alone bariatric procedure in morbidly obese patients.

BACKGROUND: The aim of this study was to define a standardized technique for laparoscopic sleeve gastrectomy in the morbidly obese patient. METHODS: There are several surgical options for the morbidy obese patient. In general, there are the restrictive procedures [e.g., laparoscopic adjustable gastric banding (LAGB)] and the malabsorptive procedures [e.g. laparoscopic Roux-en-Y gastric bypass (LRYGBP)]. Those techniques are already standardized. The laparoscopic sleeve gastrectomy (LSG) seems to have some advantages over both procedures, but it is not standardized yet, and so there can be no comparison between the different techniques. In our center we have standardized the LSG technique with respect to abdominal access and narrowness of the gastric sleeve. After dissection of the greater omentum and the short gastric vessels, the greater curvature is resected along a 34-Fr gastric tube using the Endo-GIA. The remaining gastric sleeve has a volume of about 100 ml. RESULTS: The standardized LSG procedure is presented step by step. A comparison of operative data and early outcome with a matched group of patients with adjustable gastric banding showed no difference between the two techniques with respect to operating time, surgical complications, and weight loss 6 months after surgery. CONCLUSION: With our standardized LSG technique it is possible to evaluate the positive aspects of the LSG compared with other standardized bariatric procedures like LAGB or LRYGBP.

Successful coil embolization of a ruptured gastroduodenal artery aneurysm.

Aneurysms of the gastroduodenal artery are rare. Reported here is the case of a 60-year-old woman suffering from the covered rupturing of a twin aneurysm of the gastroduodenal artery. The patient presented herself in the surgical emergency unit with abdominal discomfort. Diagnostics showed free fluid in the abdominal cavity together with anemia of 9.9 g/dL. A computed tomography scan and an angiography revealed the covered rupturing of a twin aneurysm of the gastroduodenal artery, which was treated by endovascular coiling of the gastroduodenal and pancreaticoduodenal arteries. The patient's hemoglobin level remained stable after treatment, and she was released from the hospital after 18 days. Visceral artery aneurysms are rare. Although endovascular therapy is preferred in cases involving active bleeding, surgery remains the primary therapy in those cases in which bleeding becomes uncontrollable.