Surgical endoscopy
-
Bariatric surgery has been established as the most effective long-term treatment for morbid obesity. ⋯ Bariatric surgery is feasible in the SSO patients with comparable EWL outcomes and postoperative complications to historical non-SSO patients.
-
Due to the steady increase in patients on chronic dialysis, more of these patients are undergoing elective operations. The literature on safety and postoperative outcomes in dialysis-dependent patients following elective bariatric surgery is scant. We compared the 30-day major morbidity and mortality rates in dialysis-dependent (DD) and non-dependent (ND) patients after primary bariatric surgery. ⋯ Primary bariatric surgery is safe in patients dependent on dialysis with an acceptable 30-day postoperative morbidity and mortality. Even though dependence on dialysis does not independently increase the risk of 30-day adverse outcomes following primary bariatric surgery, the comorbid conditions in this patient population render them at risk. The higher prevalence of major morbidities in this group is mainly due to the impact from older age, male sex, higher BMI, cardiac comorbidities, and hypertension.
-
Tumors in the stomach have traditionally been treated with either subtotal gastrectomy or total gastrectomy, depending on the location. However, many of these lesions are benign spindle cell tumors or adenomas and could be resected with margins. Here, we explore multiple minimally invasive methods for the resection of these tumors. We highlight a wedge resection, a circumferential resection with transverse closure, a transgastric resection, and an endoscopic/laparoscopic submucosal resection. The wedge resection was performed in a 71-year-old man found to have a mass in the stomach on screening upper endoscopy. The biopsy was not definitive, but on CT scan there was a 4.5-cm submucosal mass consistent with a gastrointestinal stromal tumor. The circumferential resection was performed for an 83-year-old woman who had abdominal discomfort which led to an upper endoscopy. She was found to have a mass in the lesser curve of her stomach. Biopsy revealed this to be a gastrointestinal stromal tumor. Ultimately, it was removed when serial CT scans showed that it was growing. The transgastric approach was used for a 75-year-old man who had upper endoscopy for reflux symptoms and was found to have a mass in the stomach. Biopsy showed that it was a gastrointestinal stromal tumor. Due to patient preference, it was initially observed but was eventually removed when it was found to be growing on serial CT scans. The endoscopic/laparoscopic approach was for a 65-year-old man who had an upper endoscopy performed for work-up of melena and was found to have a 5-cm mass at the gastroesophageal junction. The biopsy showed this to be an adenoma, and he went on to have it removed. ⋯ Minimally invasive techniques should be considered more frequently for the management of benign gastric tumors. The four methods illustrated here can be used safely and result in faster recovery as well as shorter hospital stays compared to traditional approaches.
-
Laparoscopic adjustable gastric banding (LAGB) is increasingly requiring revisional surgery for complications and failures. Removal of the band and conversion to either laparoscopic Roux-en-y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) is feasible as a single-stage procedure. The objective of this study is to compare the safety and efficacy of single-stage revision from LAGB to either LRYGB or LSG at 6 and 12 months postoperatively. ⋯ Single-stage revision from LAGB to LRYGB or LSG is technically feasible, but not without complications. The complications in the bypass group were more severe. There was no difference in readmission or reoperation rates, weight loss or comorbidity reduction. Revision to LRYGB trended toward higher rate and greater severity of complications with equivalent weight loss and comorbidity reduction.
-
Comparative Study
Predictors of readmission after laparoscopic gastric bypass and sleeve gastrectomy: a comparative analysis of ACS-NSQIP database.
Readmission rate is an indicator of quality in surgical practice. We aimed to determine the predictors of unplanned early readmissions following stapling bariatric surgeries. ⋯ Ethnicity, baseline functional status, comorbidities, type and duration of surgical procedure, and postoperative complications occurred in the index admission can predict risk of early readmission following LRYGB and LSG.