Management modalities in slipped gastric band.

BACKGROUND: Gastric band slippage is one of the possible complications of the laparoscopic gastric band (LGB). Band slippage can present as an emergency and have drastic consequences. We herein report the different treatment modalities of slipped gastric band. MATERIAL AND METHODS: A retrospective study of all patients presenting with slipped gastric band between May 2013 and January 2015 at our University hospital is described. All patients were evaluated at the time of presentation by radiological studies and upper gastrointestinal endoscopy. On diagnosis, all bands were deflated in an attempt to relieve symptoms. After patient counseling and band position evaluation, patients were consented for either removal or repositioning of the band. RESULTS: This study included 100 patients. Gastric band slippage rate was 8%. All patients presented with signs of gastric obstruction and expressed a long history of intermittent vomiting attacks. All patients were subjected to a complete gastric band deflation on presentation. Band deflation successfully relieved symptoms and reversed band slippage in 2 patients. However, both patients returned with band reslippage within the same month. The other 6 patients had persistent band slippage despite complete band deflation. Three of the 8 patients had a successful band repositioning, and the rest had their gastric bands removed. CONCLUSION: Gastric band slippage can be a serious LGB complication. Repeated vomiting can be a significant risk factor for band slippage. Moreover, band repositioning can be a well-tolerated and feasible option in the management of slipped gastric band.

Is conservative management for gastric perforation secondary to intragastric balloon possible? Case report and review of literature.

Intragastric balloon (IGB) is one of the available options for the management of morbid obesity. The procedure is generally safe and of moderate efficacy in most of the cases. One of the reported complications of IGB is gastric perforation. The management of this complication is classically surgical. To our knowledge, conservative management for gastric perforation secondary to IGB has not been reported. A 27-year-old female patient presented with sudden abdominal pain in the left upper quadrant, 2 months after having an IGB placed. The provisional diagnosis was gastric perforation. Balloon extraction was performed and a conservative management of the gastric perforation was pursued successfully. We therefore propose that this sort of management might be adopted in carefully selected cases.

Intracavernous sodium nitroprusside (SNP) versus papaverine/phentolamine in erectile dysfunction: a comparative study of short-term efficacy and side-effects.

OBJECTIVE: The aim of our work is to evaluate the efficacy of intracavernous sodium nitroprusside (SNP) in management of erectile dysfunction (ED) in a clinical comparative study with papaverine/phentolamine in ED patients. METHODS: The study included 40 patients with ED divided into two groups. Group I include 20 patients receiving intracavernous (30 mg papaverine + 1 mg phentolamine) followed 1 week later by intracavernous 300 microg SNP. Group II included 20 patients receiving the same regimen of group I but with intracavernous SNP first followed by papaverine/phentolamine 1 week later. All patients were assessed clinically for their response and any developing complications. RESULTS: The numbers of good and poor responders were not statistically significant (P > 0.05) among the two groups. The mean erectile duration of SNP was similar to bimix (P > 0.05). No side-effects whether local or systemic occurred with SNP while priapism and local penile pain were recorded with bimix solution. CONCLUSIONS: Intracavernous pharmacotherapy is still a reliable method both for diagnosis and for treatment of ED. While preliminary results of our study show a potential of SNP to be an effective and safe intracavernous agent, long-term self-injection clinical trials are needed before large-scale usage is recommended.