ABSTRACT
BACKGROUND: Acute biliary diseases during pregnancy have been classically managed conservatively. Advances in minimally invasive surgery and the high recurrence rate of symptoms observed changed this management. METHODS: This is a prospective observational study. Initial management was medical. Unresponsive patients were treated with minimally invasive techniques including gallbladder percutaneous aspiration or cholecystostomy, endoscopic retrograde cholangiography, and laparoscopic cholecystectomy, depending on the pregnancy trimester and underlying diagnosis. RESULTS: 122 patients were admitted. 69 (56.5%) were unresponsive to medical treatment. Recurrent gallbladder colic was the most frequent indication for minimally invasive intervention, followed by acute cholecystitis, choledocholithiasis, and acute biliary pancreatitis. 8 patients were treated during the first trimester, 54 during the second, and 7 during the last trimester. There was no fetal morbidity or mortality. Maternal morbidity was minor with no mortality. CONCLUSION: Acute biliary tract diseases during pregnancy may be safely treated with minimally invasive procedures according to the underlying diagnosis and to the trimester of pregnancy.
Subject(s)
Biliary Tract Diseases/surgery , Digestive System Surgical Procedures/methods , Minimally Invasive Surgical Procedures/methods , Pregnancy Complications/surgery , Acute Disease , Adolescent , Adult , Biliary Tract Diseases/diagnosis , Female , Follow-Up Studies , Humans , Length of Stay , Pregnancy , Pregnancy Complications/diagnosis , Pregnancy Outcome , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: Laparoscopic sleeve gastrectomy and its indications are currently being evaluated. The objective of this study was to show the preliminary results obtained with this technique indicated as an alternative to gastric bypass in patients with multiple intraabdominal adhesions, therefore preserving the benefits of the laparoscopic approach. METHODS: An analysis of all patients who underwent a laparoscopic sleeve gastrectomy for the above indication was done. Data included demographics, number of previous surgeries, operative time, morbidity, mortality, and %EWL at 3 and 6 months. RESULTS: Fifteen patients underwent laparoscopic sleeve gastrectomy as an alternative to gastric bypass because of multiple intraabdominal adhesions. No patient required conversion to an open procedure; morbidity was 6% with no mortality. %EWL at 3 months was 41% and at 6 months was 44%. Mean follow-up was 6 months. CONCLUSION: In our initial experience, laparoscopic sleeve gastrectomy proved to be a safe and effective alternative to gastric bypass for patients with multiple intraabdominal adhesions.
Subject(s)
Abdomen/pathology , Gastrectomy/methods , Laparoscopy , Adult , Female , Gastric Bypass , Humans , Length of Stay , Male , Middle Aged , Tissue AdhesionsABSTRACT
A case is reported of intraoperative diagnosis and treatment of a low-grade gastric MALT lymphoma during gastric bypass surgery for morbid obesity. Laparoscopic resectional gastric bypass was followed by adjuvant chemotherapy.
