Perioperative outcomes of revisional laparoscopic gastric bypass after failed adjustable gastric banding and after vertical banded gastroplasty: experience with 107 cases and subgroup analysis.

BACKGROUND: A growing number of revision procedures are to be expected in bariatric surgery after failed restrictive procedures such as failed adjustable gastric banding (AGB) or vertical banded gastroplasty (VBG). Conversion to revisional laparoscopic Roux-en-Y gastric bypass (ReLRYGBP) has been advocated as the procedure of choice. METHODS: The results of ReLRYGBP were reviewed in a retrospective chart review. A subgroup analysis compared perioperative results after VBG and after AGB. A second subgroup analysis compared perioperative results of ReLRYGBP immediately after AGB removal and after a delay as a two-step procedure. RESULTS: Between 2003 and 2009, ReLRYGBP was performed for 107 patients. Of these 107 operations, 21 were performed after failed VBG and 86 after failed AGB. The mean body mass index (BMI) was 42 kg/m(2). The causes of failure were mainly insufficient weight loss or reflux disease-related symptoms. During a median follow-up period of 44 months, there was no mortality, and morbidity was 34 %, including late complications. Major early complications occurred in 11 % of the cases (n = 12). Conversions and major early complications occurred significantly more frequently after VBG than after AGB (p < 0.05). In 59 % of the cases (n = 50), ReLRYGBP was performed as a single-stage procedure immediately after removal of AGB and in 41 % of the cases (n = 36) as a delayed two-step procedure. The outcomes did not differ significantly (p > 0.5). CONCLUSIONS: The perioperative outcomes of ReLRYGBP are worse after VBG than after AGB. The ReLRYGBP operation can be performed safely as a one-step procedure after AGB removal.

[Heparin-associated thrombocytopenia]. / Heparine geassocieerde thrombocytopenie.

Thrombocytopenia and heparin. Heparin associated thrombocytopenia (HAT), more specially type 2, is an important complication of anticoagulant treatment in clinical practice. Diagnosis may be difficult and requires special laboratory techniques. Platelet count should be performed every two days. Severe complications may occur in 23% of type 2 HAT patients and is associated with a high mortality. Until now there are no prophylactic measurements for high risk patients.

Emphysematous pyelonephritis.

A case of emphysematous pyelonephritis with gas formation extending into the renal vein is presented. Diagnostic procedures and aggressive surgical management are discussed.

[Diverticulosis of the appendix]. / Diverticulosis van de appendix.

Diverticulosis of the appendix. Diverticulosis of the appendix is a rare condition. Cause of the danger of perforation, it is not an unimportant entity. We present six examples and review its pathogenesis, diagnosis and treatment.

Implantation of a dual chamber pacemaker in a patient with persistent left superior vena cava.

A patient underwent dual chamber pacemaker implantation by puncture of the left subclavian vein. During the procedure we observed persistence of the left superior vena cava. A "J-shaped" atrial lead was used for ventricular pacing with excellent long-term results. This technique can be a valuable alternative when confronted with the problem of persistent left superior vena cava during pacemaker implantation.

Hazards of nasopharyngeal oxygen therapy: a case of iatrogenic stomach rupture.

Iatrogenic rupture of the stomach has been reported as a rare complication of nasopharyngeal oxygen therapy. A new case of this life-threatening condition is reported and diagnostic, therapeutic and preventive measures are briefly discussed.

[Volvulus of the cecum and sigmoid]. / Volvulus van het caecum en sigmoid.

Five cases of volvulus, four of the sigmoid and one of the cecum are presented. Etiology, symptomatology, diagnosis and therapy are discussed.