Emergent conversion from single-anastomosis gastric bypass to Roux-en-Y gastric bypass with subsequent obstruction of entero-enteric anastomosis by ascaris.

One anastomosis gastric bypass (OAGB), the third most commonly performed procedure worldwide, has shown excellent results in terms of weight loss and resolution of comorbidities compared with other bariatric surgeries. However, its use remains limited in various parts of the world due to postoperative complications. After the efficacy of this procedure was established, the focus of treatment shifted toward resolving postoperative complications. Protein-energy malnutrition after OAGB is one of the main issues that needs to be addressed. There are several operative options for patients who require revision surgery including reversal and conversion to Roux-en-Y gastric bypass (RYGB). The conversion from OAGB to RYGB is a feasible method that has shown excellent results when performed by experts in the field. Here, we present the case of a woman with symptoms of acute obstruction secondary to OAGB who underwent conversion to RYGB under emergent conditions.

Hybrid management with graham patch repair assisted with an OVESCO endoscopic system for a post-Nissen fundoplication gastric fistula: A case report.

INTRODUCTION AND IMPORTANCE: Gastric fistula is a complication in gastrointestinal surgery. For decades, patients with gastric fistulas were treated surgically, with high morbidity and mortality. Minimally invasive treatment through endoscopic therapy with stents and interventionism has allowed improvements. We present a case of successful hybrid laparoscopy and endoscopy for the treatment of a post-Nissen fundoplication gastric fistula. CASE PRESENTATION: A 44-year-old male underwent laparoscopic Nissen fundoplication surgery; at 10 days post-surgery, he presented with oral intolerance, abdominal pain, and laboratory results showing an inflammatory response. Imaging studies indicated intra-abdominal collection; therefore, a laparoscopy revision was performed; transoperative endoscopy confirmed intra-abdominal collection and a gastric fistula. In turn, we performed closure with an omentum patch through the fistula fixed with OVESCO by endoscopy, with successful results. CLINICAL DISCUSSION: Gastric fistula is a difficult complication to treat because exposure to secretions causes inflammation. Endoscopic techniques are described for the closure of gastrointestinal fistulas; however, several aspects must be considered for their use. Hybrid laparoscopic and endoscopic treatment in the same surgery can be useful and served as a novel and successful option in our case. CONCLUSION: Hybrid treatment with endoscopy and laparoscopy can be considered an optional approach for the management of gastric fistulas greater than 1 cm and of several days of evolution.