Endoscopic dilation with Savary-Gilliard bougies of stomal strictures after laparosocopic gastric bypass in morbidly obese patients.

BACKGROUND: Anastomotic strictures after bariatric surgery are a frequent complication that requires endoscopic management, but the optimal technique for dilation remains to be determined. The aim of this study was to evaluate the safety and efficacy of dilation with Savary-Gilliard bougies (SGB) in morbidly obese patients treated with laparoscopic Roux-en-Y gastric bypass (RYGBP). PATIENTS AND METHODS: Retrospective review of prospectively collected data from a series of 474 consecutive patients with laparoscopic bariatric surgery. Four-hundred twenty four of these patients (90%) underwent a laparoscopic RYGBP. A total of 24 patients were referred for anastomotic stricture dilation with SGB from January 1998 to December 2006. RESULTS: A total of 24/424 patients (6%) developed a stricture that was successfully dilated with SGB. Patients were 17 females (71%) and seven males (29%) with a mean age of 41 +/- 11 years (range 24-63) and a mean BMI of 48 +/- 6 (range 40-69). The time between RYGBP and the appearance of stricture-related symptoms ranged from 29 to 154 days (mean, 69 days). The mean number of dilations was 1.6 +/- 0.6. The majority of patients required one (n = 11; 46%) or two (n = 12; 50%) dilations and only one patient required three dilations. During the initial dilation, a final diameter of 11 +/- 1.7 mm (range 7-12.8 mm) was achieved. In all cases, there was complete resolution of symptoms. There were no complications. CONCLUSIONS: Dilation with SGB is an effective, safe, and durable method for managing anastomotic strictures after laparoscopic RYGBP.

Current attitudes to the laparoscopic bariatric operations among European surgeons.

BACKGROUND: The current attitudes among European bariatric surgeons toward the laparoscopic bariatric operations were examined. METHODS: 150 questionnaires were sent to recognized bariatric surgeons in Europe, and 60% responded. RESULTS: 47% of respondents perform laparoscopic Roux-en-Y gastric bypass (LRYGBP), 81% laparoscopic adjustable gastric banding (LAGB), and 29% laparoscopic biliopancreatic diversion with or without duodenal switch (L-BPD/BPDDS). For BMI <40, 57% of respondents would only perform LAGB, 7% LRYGBP, 2% vertical banded gastroplasty (VBG), 3% L-BPD/BPDDS, and 2% intra-gastric balloon. For BMI 40-50, 43% of respondents prefer LAGB, 11% LRYGBP, 8% VBG, 5% L-BPD/BPDDS, and 33% contemplate several operations. For BMI 50-60, 30% prefer LAGB, 23% LRYGBP, 5% VBG, 16% L-BPD/BPDDS, and 26% tailor each patient's treatment. For BMI >60, 20% prefer LAGB, 24% LRYGBP, 37% L-BPD/BPDDS, 2% VBG, and 17% consider more than one operation. Although important, BMI and patient eating habits are not significant in choosing an operation for 25% of respondents. Interestingly, 39% of the surgeons offer laparoscopic bariatric surgery to so-called pediatric patients (<18). Of these, 76% favor LAGB, 8% LRYGBP, 8% L-BPD and 4% other procedures. CONCLUSIONS: The overall body of respondents prefers laparoscopic procedures. The responses suggest that at lower BMI there is a higher trend for restrictive operations. However, as BMI increases, combined and malabsorptive operations are preferred. At least one-third of surgeons offer bariatric surgery to patients with age <18 years, and here LAGB is greatly preferred.

Laparoscopic assisted colectomies in kidney transplant recipients with colon cancer.

BACKGROUND: Kidney transplant recipients have increased operative risks for major abdominal surgery. The purpose of this study is to present the results of laparoscopic assisted colectomies (LAC) in patients who have received a kidney transplant, and evaluate the difficulty and potential benefits or hazards inherent in this approach. PATIENTS AND METHODS: From September 1993 to March 2003, 820 patients underwent LAC in our service. We studied all patients with kidney transplant and LAC. RESULTS: Three kidney transplantation recipients were included. Two patients were female and one male. The mean age was 65 years (range, 54-73 years). The average time elapsed since transplantation was 8 years (range, 6-10 years), and no patient had experienced problems with rejection. All patients had colon cancer. All of the allografts were contralateral to the side of the colon resection. The mean operative time was 103 minutes (range, 100-105 minutes). There were no complications, renal function remained intact, and there was no need to stop immunosuppression. The average length of hospital stay was 5 days (range, 4-7 days). The mean followup time has been 17 months (range, 3-40 months). Since surgery there have been no episodes of rejection and the patients have been free of cancer. CONCLUSION: The benefits of minimal access surgery seem to be shared by kidney transplant recipients. A key feature may be to avoid stopping immunosuppression perioperatively, therefore lowering the potential risk of rejection. Also, lessening the number of wound-related problems appears important for these patients. LAC in experienced hands must be considered a safe alternative for elective colon resections in highly selected patients with kidney transplants.