Gallbladder plication as a rare complication of endoscopic sleeve gastroplasty: A case report.

BACKGROUND: Endoscopic sleeve gastroplasty (ESG) is a minimally invasive procedure used in the treatment of obesity, with a complication rate of less than 2% of cases. There have been only two reported cases worldwide of gallbladder injuries as a major complication of ESG. CASE SUMMARY: We present the case of a 34-year-old patient who developed a complication after ESG. The patient experienced epigastric and right hypochondrium pain 12 h after the procedure, and a positive Murphy's sign was identified on physical examination. Laboratory results showed a leukocyte count of 17 × 103/µL, and computed tomography indicated the presence of free fluid in the pelvic cavity and perihepatic recesses as well as a possible suture in the wall of the Hartmann's pouch toward the anterior surface of the stomach. A diagnostic laparoscopy was performed, revealing plication of the Hartmann's pouch wall to the anterior stomach wall. Laparoscopic cholecystectomy and lavage were carried out. The patient had a stable recovery and was discharged 72 h after surgery, tolerating oral intake. CONCLUSION: Gallbladder plication should be suspected if signs and symptoms consistent with acute cholecystitis occur after ESG.

Intraoperative endoscopy prevents technical defect related leaks in laparoscopic Roux-en-Y gastric bypass: A randomized control trial.

BACKGROUND: Postoperative anastomotic leaks, bleeding and stenosis are major causes of morbidity after laparoscopic Roux-en-Y gastric bypass (LRYGB). Retrospective studies suggest that intraoperative endoscopy reduces the incidence of these complications. METHODS: We conducted a prospective randomized controlled trial in a single institution between March 2013 and January 2016. Patients were assigned to one of two groups: LRYGB with Intraoperative Endoscopy (IOE) or LRYGB without IOE. Patient selection criteria were morbidly obese patients, 18 years or older who were candidates to LRYGB. The primary outcome was the frequency of technical defect related anastomotic leaks. Secondary outcomes were operative time, length of hospital stay, anastomotic related complications, reoperations and 30-day mortality. RESULTS: 50 patients were randomly assigned in the IOE group and 50 in the control group. The IOE group had statistically significant lower rate of anastomotic leak (0 vs. 8%, p = .0412), and lower need for reoperation (0 vs. 8%, p = .0412). The IOE group had longer operative time (194.10 vs. 159 min, p < .001), and shorter mean length of hospital stay (2.44 vs. 3.46 days, p = .025). No differences were found in the rate of bleeding of the anastomosis, narrow anastomosis and 30-day mortality. CONCLUSION: This study specifically provides evidence that air leak test performed by intraoperative endoscopy is superior to simple visual inspection in preventing technical defect related leaks after laparoscopic Roux-en-Y gastric bypass.

Adipocyte Size and Leptin Receptor Expression in Human Subcutaneous Adipose Tissue After Roux-en-Y Gastric Bypass.

The molecular mechanisms implicated in pronounced weight loss and metabolic benefits after bariatric surgery are still unknown. Adipocyte phenotype and metabolism have not been entirely explored. However, some features of adipocyte function have been studied, such as adipocyte size and inflammation, which are both reduced after bariatric surgery. Adipocyte fat metabolism, which is partly regulated by leptin, is likely modified, since adipocyte area is decreased. Here, we show that leptin receptor expression is increased, while adipocyte size is decreased 8 months after Roux-en-Y gastric bypass. Thus, adipocyte function is possibly modified by improved leptin signaling after bariatric surgery.

Colédoco-duodeno anastomosis laparoscópica / Laparoscopic Choledochoduodenostomy

Introducción: Las opciones actuales para realizar procedimientos permanentes de derivación biliodigestiva, secundarios a coledocolitiasis compleja, van desde la cirugía abierta hasta el empleo de procedimientos híbridos laparoendoscópicos. El objetivo del estudio fue realizar un análisis de los resultados obtenidos en pacientes con coledocolitiasis compleja tratados con colédoco-duodeno anastomosis laparoscópica. Métodos: Se realizó un estudio observacional longitudinal en el período comprendido de marzo de 2011 a junio de 2016. Se incluyeron pacientes con coledocolitiasis compleja no resuelta por CPRE o resueltas por CPRE pero con dilatación masiva de vía biliar y evidencia de colestasis persistente, los cuales fueron seleccionados para procedimiento quirúrgico con colédoco-duodeno anastomosis. Resultados: Se incluyeron un total de 19 pacientes. La mayoría mujeres (78,9%), con edad media avanzada (72,4 ± 12 años) y con múltiples comorbilidades. Todos con al menos un episodio (mín-máx: 1-7) de coledocolitiasis o colangitis previos. El diámetro del colédoco fue de 24,9 ± 7mm. El tiempo quirúrgico fue de 218,5 ± 74 min, sangrado de 150 (30-600) mL, inicio de dieta en 3,2 ± 1 días y estancia hospitalaria postoperatoria de 4,9 ± 2 días. Se encontró una mediana de 18 (12-32) meses de seguimiento. Posterior al procedimiento se observó normalización de las pruebas de funcionamiento hepático. Un paciente presentó síndrome del sumidero y un paciente falleció por neumonía nosocomial. Conclusiones: La colédoco-duodeno anastomosis laparoscópica asistida con coledocoscopia representa una técnica segura y eficaz para el tratamiento de pacientes con coledocolitiasis compleja con indicación de derivación biliodigestiva, ofreciendo los beneficios de la cirugía de mínima invasión (AU)

Introduction: Today's options for biliary bypass procedures, for difficult choledocholithiasis, range from open surgery to laparo-endoscopic hybrid procedures. The aim of this study was to analyze the outcomes of patients with difficult choledocholithiasis treated with laparoscopic choledochoduodenostomy. Methods: We performed a prospective observational study from March 2011 to June 2016. We included patients with difficult common bile duct stones (recurrent or unresolved by ERCP) in which a biliary bypass procedure was required. We performed a laparoscopic bile duct exploration with choledochoduodenostomy and intraoperative cholangioscopy. Results: A total of 19 patients were included. We found female predominance (78.9%), advanced mean age (72.4 ± 12 years) and multiple comorbidities. Most patients with previous episodes of choledocholitiasis or cholangitis, mode 1 (min-max: 1-7). Mean common bile duct diameter 24.9 ± 7mm. Mean operative time 218.5 ± 74min, estimated blood loss 150 (30-600) mL, resume of oral intake 3.2±1 days, postoperative length of stay 4.9 ± 2 days. We found a median of 18 (12-32) months of follow-up. All patients with normalization of liver enzymes during follow-up. One patient presented with sump syndrome and one patient died due to nosocomial pneumonia. Conclusions: Laparoscopic choledochoduodenostomy with intraoperative cholangioscopy seems to be safe and effective treatment for patients with difficult common bile duct stones no resolved by endoscopic procedures. This procedure is a good option for patients with advanced age and multiple comorbidities. We offer all the advantages of minimally invasive surgery to these patients (AU)

Correlation between the gastrojejunostomosis area, documented endoscopically, and the loss of weight in laparoscopic gastric bypass postoperative patients: results of 1 year after surgery.

Laparoscopic Y Roux gastric bypass (YRGB) is the most performed bariatric surgery. There are 3 main techniques in the construction of the gastrojejunostomosis (GJA). The size of the GJA and its relation to the reduction of excess weight has been previously debated. The aim of our study was to determine whether the GJA area in YRGB correlates with the loss of excess weight at 1 year postoperatively. Patients who complied 1 year after YRGB underwent an upper gastrointestinal endoscopy. Images of the GJA were obtained and the area of the GJA was calculated. A statistical analysis, adjusting for age and body mass index preoperatively obtained an r of -0474 and P=0.032, demonstrating a significant negative correlation between the GJA area and the percentage of excess weight loss. A statistically significant negative correlation between the GJA area and the percentage of the excess weight loss was shown. The number of patients evaluated should be increased for a higher statistical significance to corroborate whether the stoma size influences the loss of weight in YRGB patients.

Correlación de los hallazgos endoscópicos pre y postoperatorios en pacientes sometidos a cirugía bariátrica / Correlation of pre and postoperative endoscopic findings in patients subjected to bariatric surgery

Objetivo: Establecer una correlación de los hallazgos endoscópicos preoperatorios con los síntomas gastrointestinales y hallazgos endoscópicos en el seguimiento de los pacientes sometidos a algún tipo de cirugía bariátrica. Sede: Hospital General ''Dr. Manuel Gea González''. Tercer Nivel de Atención Médica. Diseño: Estudio retrospectivo, descriptivo, transversal y comparativo. Análisis estadístico: Porcentajes como medida de resumen para variables cualitativas y χ². Pacientes y método: Pacientes que se operaron en la clínica de obesidad, de junio 2006 a junio 2010, a los cuales se les realizó endoscopia preoperatoria con un seguimiento mínimo de un año. Se identificaron las patologías gastrointestinales con mayor incidencia, hallazgos histopatológicos y la correlación de la endoscopia postoperatoria en el seguimiento de pacientes que por sus síntomas requirieron control endoscópico. Resultados: De un total de 137 pacientes que cumplieron con los criterios de inclusión (111 mujeres, 26 hombres), con edad promedio de 36.41, IMC promedio de 42.04, la patología con mayor incidencia fue gastritis inespecífica no erosiva (45.25%), el resultado histopatológico más frecuente fue gastritis asociada a Helicobacter pylori (HP) (38.6%). A un seguimiento promedio de tres años (DE ± 1.31) a 35 pacientes (25.5%) se les realizó endoscopia de seguimiento por síntomas gastrointestinales; los hallazgos endoscópicos fueron: gastritis inespecífica no erosiva (54.28%), sin alteraciones (31.42%) y estenosis de anastomosis (14.7%). Conclusión: La endoscopia preoperatoria es de gran utilidad, ya que permite identificar patologías que se pueden asociar a otras complicaciones y tomar todas las medidas para prevenirlas.

Objective: To establish a correlation between the pre-operative endoscopic findings with the gastrointestinal syndrome and endoscopic findings during follow-up of patients subjected to bariatric surgery. Setting: General Hospital ''Dr. Manuel Gea González'' (third level health care center). Design: A retrospective, descriptive, cross-sectional, comparative study. Statistical analysis: Percentages as summary measures for qualitative variables and χ². Patients and method: Patients operated in the obesity clinic from June 2006 to June 2010, in whom a preoperative endoscopy was performed with a follow-up of at least 1 years. We identified the gastrointestinal pathologies with the highest incidence, histopathological findings, and the correlation with the postoperative endoscopy during the follow-up of patients, who, due to their symptoms, required endoscopic control. Results: In a total of 137 patients that complied with the inclusion criteria (111 women and 26 men), average age of 36.41 years, average BMI of 42.04, the pathology with the highest incidence was non-specific non-erosive gastritis (45.25%), the most frequent histopathological result was gastritis associated to Helicobacter pylori (HP) (38.6%). At an average follow-up of three years (SD ± 1.31), 35 patients (25.5%) were subjected to follow-up endoscopy due to gastrointestinal symptoms. Endoscopic findings were: non-specific, non-erosive gastritis (54.28%), without alterations (31.42%), and stenosis of the anastomoses (14.7%). Conclusion: Preoperative endoscopy is very useful as it allows identifying pathologies that can be associated to other complications and taking the necessary measures to prevent them.