Laparoscopic Sleeve Gastrectomy with Staple-Line Oversewing in a Patient with Factor XI Deficiency: A Case Report.

BACKGROUND Bariatric surgery (BS) has a lower percentage of complications than other abdominal surgeries. Hemorrhage in one of the most common complications and can be life-threatening. Hereditary factor XI (FXI) deficiency is a coagulation disorder that can result in excessive bleeding requiring intervention to restore hemostasis. Risks over benefits in patients with morbid obesity with BS indication, as well as those with FXI deficiency, should be carefully evaluated. This article reports the case of an obese woman with FXI deficiency -undergoing SG. CASE REPORT A 49-year-old woman with a BMI of 51 kg/m² was diagnosed as having severe FXI deficiency during preoperative exams prior to bariatric surgery. Virus-inactivated homo-group plasma 10 ml/kg infusion was administrated 1 h before surgery, during the entire procedure, and continuing until postoperative day (POD) 4. A very low-calorie ketogenic diet (VLCKD) was proposed to the patient 4 weeks before surgery. Laparoscopic sleeve gastrectomy was performed with staple-line reinforcement by oversewing the seromuscular layer using continuous suture. Subcutaneous enoxaparin 4000 U.I. was administered from POD 1 until POD 25 to prevent any thromboembolic event. The patient was discharged on POD 5 in good clinical condition. CONCLUSIONS Risks of bleeding andor thromboembolic events before or after BS are increased in patient with FXI deficiency. Bariatric surgery in these patients is safe in experienced BS centers, and the risks associated with the obesity seem to exceed those of the coagulopathy and surgery. Careful preoperative counseling, extensive hematological checks, and meticulous surgery are essential to reduce BS risks. Sleeve gastrectomy oversewing the stapler line seems a reasonable choice.

Internal herniation of small bowel through the minimizer ring after banded one anastomosis gastric bypass: Case report with diagnosis and management of a rare complication.

INTRODUCTION: One Anastomosis Gastric Bypass has been increasingly performed in the setting of bariatric surgery. The addition of gastric pouch banding (BOAGB) may reduce weight regain in the long term. BOAGB may rarely be complicated by MiniMizer ring-related affections. This article reports for the first time a case of bowel obstruction due to internal hernia (IH) through the ring itself, occurring 15 months after BOAGB. CASE REPORT: A 55 years-old woman presented with unspecific symptoms of sub-acute bowel obstruction 15 months after BOAGB. Work-up revealed IH through the MiniMizer ring and its erosion into the liver. Successful management included laparoscopic ring removal and adhesion-lysis. Postoperative course was uneventful. DISCUSSION AND CONCLUSION: IH through MiniMizer ring is a rare complication of BOAGB and awareness of this possibility may help diagnosis and prevention. Diagnosis requires high index of suspicion and per-oral contrast CT. Successful management entails laparoscopic device removal. Prevention includes non re-absorbable suture fixation and adequate gastric pouch encirclement.