Failed gastroplasty for morbid obesity. Revised gastroplasty versus Roux-Y gastric bypass.

Forty-six percent of 122 gastroplasties for morbid obesity failed. This included a failure rate of 71 percent for a single staple line without stomal reinforcement, 37 percent for a double staple line and a central stoma reinforced with 2-0 polypropylene, and 42 percent for the Gomez gastroplasty. Revisional procedures were performed in 44 patients. Ten underwent revision of a failed gastroplasty using a gastrogastrostomy and 34 had conversion to a Roux-Y gastric bypass. Patients who had revisional gastroplasty as a second procedure had a significantly higher failure and complication rate than those converted to gastric bypass. Four of these 10 patients were subsequently converted to gastric bypass as their third weight reduction procedure. Conversion of a failed gastroplasty to a Roux-Y gastric bypass is a difficult procedure that carried a significantly higher complication rate in our study than that of a group of 46 patients who underwent a primary gastric bypass procedure. Of 26 patients followed for more than 1 year after conversion to Roux-Y gastric bypass, the average weight loss was 66 +/- 18 percent of their excess body weight. This was comparable to 16 patients who had undergone a primary gastric bypass more than 1 year previously and had lost 69 +/- 17 percent of their excess body weight.

Comparison of three cognitive strategies in altering pain behaviors on a cold pressor task.

The efficacy of three cognitive strategies for coping with pain was examined in a cold-water pressor task in a sample of college students. Subjects were pretested and then randomly assigned to one of three treatment conditions (Paradoxical Intention, Rational Self-statement, or Self-observation) or to an expectancy control group. Following training in the respective cognitive strategies, all groups were given a posttest in the cold-water pressor to determine the effectiveness of the treatment. Pain thresholds, tolerances, and discomfort ratings were recorded for subjects in each condition. No differences were found between the Paradoxical Intention or Rational Self-statement groups and the Expectancy Control on any of the pain measures. The Self-observation treatment condition, however, had significantly higher pain tolerance scores than the Expectancy Control group. The findings were attributed to the subjects' dissociating the sensory aspects of the pain experience from the anxiety when focusing upon the coldness and wetness of the cold water.

Stomal disruption in gastric partition in morbid obesity (comparison of radiographic and endoscopic diagnosis).

Twenty-two patients who had gastric partition surgery for morbid obesity and subsequently developed stomal dilatation were evaluated with both upper gastrointestinal barium examinations and upper endoscopy. Both examinations were positive in eight patients. Endoscopy alone was positive in 14, but retrospective view of the upper gastrointestinal series was positive in nine of the patients. The authors stress the importance of a dedicated radiologist in performing these difficult examinations and the need for specific measurements of the stomal diameter.

Endoscopic dilation of late stomal stenosis. Its use following gastric surgery for morbid obesity.

We have observed 16 cases of stomal stenosis occurring late after gastric surgery for morbid obesity. In one patient no stoma was apparent in the pouch on radiographic or endoscopic examination and reoperation was required for complete obstruction. We dilated stenoses in the remaining 15 patients. Stenosis in the three earliest patients in our series were dilated with Eder-Puestow dilators. All subsequent patients have received endoscopic dilation with pneumatic balloon catheters. Ten patients remain asymptomatic following dilation. Two patients have occasional vomiting, which is ameliorated by metoclopramide hydrochloride, despite a sufficiently patent stoma. Two patients with a torsion of the stoma received no benefit from dilation, and one patient with a sufficiently patent stoma has experienced frequent vomiting. Surgery has been repeated in the latter three patients. The technique of endoscopic pneumatic balloon catheter dilation is a safe and effective means of dilating stomal stenoses occurring late after gastric surgery for morbid obesity.

Endoscopic-assisted tube placement for decompression of acute colonic pseudo-obstruction.

A case of acute pseudo-obstruction of the colon is presented. Treatment consisted of placing a Bilbao-Dotter hypotonic duodenography tube in the transverse colon, threaded over an angiographic guidewire placed endoscopically. A discussion of acute pseudo-obstruction of the colon is given.

Hepatic biloma complicating sickle cell disease. A case report and a review of the literature.

Previously reported hepatobiliary complications of sickle cell disease include cholelithiasis, intrahepatic cholestasis, cirrhosis, hepatic crisis, abscess, and infarction. We present a case of right upper quadrant pain, fever, and jaundice in a patient with sickle cell disease. An expanding intrahepatic bile-filled cyst ("biloma") was demonstrated as a possible consequence of hepatic infarction. The literature regarding the possible pathogenesis of this entity is reviewed.

Perforation and hemorrhage of a non-Meckelian ileal diverticulum: preoperative angiographic diagnosis.

A 54-year-old male with infective bacterial endocarditis experienced right lower quadrant pain and gastrointestinal hemorrhage. The clinical impression of hemorrhagic diverticulitis was supported by the preoperative angiographic findings of a collection of extravasated contrast material in the right lower quadrant of the abdomen originating from a branch of the ileocolic artery. Exploratory laparotomy and pathologic examination of the resected specimen confirmed an ileal diverticulum which had perforated and was the source of hemorrhage.