Omentopexy during laparoscopic sleeve gastrectomy: Is it effective in reducing postoperative gastrointestinal symptoms. A retrospective cohort study.

BACKGROUND: Postoperative gastrointestinal symptoms are common in patients undergoing sleeve gastrectomy. This study is aimed to assess the effectiveness of omentopexy during laparoscopic sleeve gastrectomy in reducing gastrointestinal symptoms. METHODS: A retrospective analysis of patients who underwent laparoscopic sleeve gastrectomy with and without omentopexy in the period between January 2016 to September 2017. All procedures were performed by three surgeons utilizing the same surgical technique. Data extracted included patient socio-demographics', preoperative body mass index (BMI), hospitalization period, treatments and post-operative gastrointestinal symptoms. It contained the GERD-Health Related Quality of Life Questionnaire (GERD-HRQL) measuring symptom severity in gastro esophageal reflux disease (GERD). Data were analyzed at 6, 12 and 18 months with reference to weight loss. RESULTS: A total of 140 patients were included in this study, 70 in each group arm. Age, preoperative BMI, pre-operative co-morbid conditions like hypertension, diabetes, and asthma were considered as confounding variables among the two groups. None of the previous factors were statistically significantly different among both groups. The outcomes of both groups were compared in terms of postoperative nausea, vomiting, regurgitation, intra-hospital stay, medication use, early return to work, and EWL%. None of the previous outcomes except for days of hospital stay and ondansetron use was found to be significantly different between both groups. CONCLUSION: Omentopexy does not change the outcome for laparoscopic sleeve gastrectomy in terms of gastrointestinal symptoms or weight loss results.

Symptomatic Giant Primary Nonparasitic Splenic Cyst Treated with Laparoscopic Decapsulation: A Case Report and Literature Review.

BACKGROUND Primary nonparasitic splenic cysts (PNSC) are unusual epithelial fluid lesions of the spleen. They are considered congenital cysts and are often discovered incidentally in young people. Larger cysts can be symptomatic and are traditionally managed with splenectomy. This report is of a woman with a large symptomatic PNSC that was managed surgically by laparoscopic decapsulation. CASE REPORT A 22-year-old Lebanese woman presented with left upper-quadrant pain, left pleuritic pain, food intolerance, and significant weight loss. Investigations showed a 20×17×15 cm cystic lesion in the spleen. Secondary causes were ruled out and tumor marker and hydatid serology were unremarkable. Laparoscopic decapsulation of the cyst with spleen preservation was performed with no perioperative complications. The patient's 3-year follow-up visit revealed no clinical or radiological recurrence. CONCLUSIONS True congenital splenic cysts are rare clinical findings. Generally, they do not have malignant potential. The development of minimally invasive techniques has shifted the trend toward splenic salvaging procedures. Literature review revealed an acceptable recurrence rate with near-total rather than partial unroofing. Laparoscopic decapsulation can be a safe and adequate therapeutic option in selected cases.

A Complication of an Endoscopic Pigtail Stent Migration into the Cavity during Deployment as a Treatment for Gastric Leak.

Gastric leak following gastrointestinal surgery is the most dreadful complication, which implies long hospital stay, morbidities, and not irrelevant mortalities. There is no standard recommendation for treating postlaparoscopic sleeve gastrectomy leak, which makes its management challenging. Endoscopic internal drainage by double-pigtail drains currently became the recommended approach. Complications to this approach include bleeding, ulceration at the tip of the double-pigtail stent, and uncommon migration. Here, we report our experience with drain displacement into the cavity while deployment in a patient who experienced gastric leakage after undergoing sleeve gastrectomy.