ABSTRACT
BACKGROUND: At present, long-term results after conservative treatment of morbid obesity (body mass index > 40) are not satisfying, given a relapse rate > 95%. In comparison, surgical treatment is about 10 times more efficient and, thus, more cost-effective. SURGICAL TECHNIQUES: Currently performed surgical interventions to induce weight loss are dominated by two major surgical procedures: (1) Mason's vertical gastroplasty, and (2) the insertion of an adjustable gastric band, developed by Kuzmak in 1983. Essential advantages of gastric banding include the possibility of laparoscopic performance and complete reversibility of the operation. After removal of the gastric band, stomach and upper intestine are left in their anatomic and functional integrity. PATIENTS AND RESULTS: During a 30-month period, we implanted the adjustable gastric band in 71 patients (65 female and six male patients). All procedures were performed laparoscopically. In none of the cases did intraoperative complications occur. Postoperatively 1.4% of the patients developed a slippage of the gastric band, 2.1% had complications concerning the subcutaneously placed port, and, eventually, the gastric band had to be removed in 1.4%.
Subject(s)
Gastroplasty , Gastroplasty/instrumentation , Postoperative Complications/etiology , Adult , Body Mass Index , Cost-Benefit Analysis , Female , Gastroplasty/economics , Humans , Laparoscopy , Male , Middle Aged , Reoperation , Surgical Instruments , Treatment OutcomeABSTRACT
The value of laparoscopic treatment of perforated gastroduodenal ulcers remains to be determined. To evaluate this modality the results of laparoscopic treatment of 18 patients with perforated gastroduodenal ulcers were compared with 28 patients who were operated by open access. Patients operated on conventionally had a mean ASA score of 2.9 compared to 1.8 in the laparoscopic group (p = 0.0009). Operative time revealed no difference between both groups, no patient had to be converted. Morbidity and mortality was 16.7% (3/18) and 0% in the laparoscopic group compared to 10.7% (3/28) and 35.7% (10/28) in the open group (p = 0.41 and p = 0.19). The mean postoperative hospital stay was 9.4 compared to 15.3 days (p = 0.15). The laparoscopic treatment of perforated gastrointestinal ulcers is an effective method, which can be used in suited patients with a low morbidity and mortality.
Subject(s)
Duodenal Ulcer/surgery , Emergencies , Laparoscopy , Peptic Ulcer Perforation/surgery , Stomach Ulcer/surgery , Adult , Aged , Duodenal Ulcer/mortality , Female , Humans , Male , Middle Aged , Peptic Ulcer Perforation/mortality , Postoperative Complications/mortality , Retrospective Studies , Stomach Ulcer/mortality , Survival RateABSTRACT
The aortoenteric fistula is one of the rare causes of gastrointestinal bleeding. A 73 year old patient presented with a secondary fistula after implantation of a synthetic graft. The diagnosis was confirmed by endoscopy. At elective laparotomy, a communication between the graft and the duodenum was discovered. Principally the combination of gastrointestinal bleeding and aortic graft is always suspicious of an aortoenteric fistula. The treatment must be surgical.
