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Obesity Surgery Mar 2024A large variation in outcome has been reported after sleeve gastrectomy (SG) across countries and institutions. We aimed to evaluate the effect of surgical technique on... (Observational Study)
Observational Study
INTRODUCTION
A large variation in outcome has been reported after sleeve gastrectomy (SG) across countries and institutions. We aimed to evaluate the effect of surgical technique on total weight loss (TWL) and gastro-esophageal reflux disease (GERD).
METHODS
Observational cohort study based on data from the national registries for bariatric surgery in the Netherlands, Norway, and Sweden. A retrospective analysis of prospectively obtained data from surgeries during 2015-2017 was performed based on 2-year follow-up. GERD was defined as continuous use of acid-reducing medication. The relationship between TWL, de novo GERD and operation technical variables were analyzed with regression methods.
RESULTS
A total of 5927 patients were included. The average TWL was 25.6% in Sweden, 28.6% in the Netherlands, and 30.6% in Norway (p < 0.001 pairwise). Bougie size, distance from the resection line to the pylorus and the angle of His differed between hospitals. A minimized sleeve increased the expected total weight loss by 5-10 percentage points. Reducing the distance to the angle of His from 3 to just above 0 cm increased the risk of de novo GERD five-fold (from 3.5 to 17.8%).
CONCLUSION
Smaller bougie size, a shorter distance to pylorus and to the angle of His were all associated with greater weight loss, whereas a shorter distance to angle of His was associated with more de novo reflux.
Topics: Humans; Obesity, Morbid; Retrospective Studies; Gastrectomy; Gastroesophageal Reflux; Weight Loss; Laparoscopy; Treatment Outcome
PubMed: 38329707
DOI: 10.1007/s11695-023-07018-y -
Journal of Indian Association of... 2023Gastric outlet obstruction in neonates due to nonhypertrophic pyloric stenosis (NHPS) is a rare cause. We report the case of a 37-day-old baby boy who presented with...
Gastric outlet obstruction in neonates due to nonhypertrophic pyloric stenosis (NHPS) is a rare cause. We report the case of a 37-day-old baby boy who presented with complaints of vomiting for the last 2 weeks and an inconsolable cry over the last 2 days. He has been vomiting seven to eight times a day, a few hours after breastfeeding. On ultrasonography, the stomach was distended, while the pylorus was not hypertrophied. An upper gastrointestinal (GI) contrast study was done, which was suggestive of gastric volvulus. We performed a laparoscopy for the same. Intraoperatively, the volvulus was already resolved. We performed gastropexy. Postoperatively, he had persistent symptoms, for which an upper GI endoscopy was performed. It demonstrated a narrow pylorus, consistent with the NHPS. We performed a laparoscopic Heineke-Mikulicz pyloroplasty. The patient's symptoms had improved postoperatively. He was discharged after 5 days.
PubMed: 37842226
DOI: 10.4103/jiaps.jiaps_157_22 -
Journal of Gastric Cancer Oct 2023Intra-abdominal infection is a common postoperative complication of laparoscopic pylorus-preserving gastrectomies (PPGs). Many studies have reported that intra-abdominal...
PURPOSE
Intra-abdominal infection is a common postoperative complication of laparoscopic pylorus-preserving gastrectomies (PPGs). Many studies have reported that intra-abdominal infectious complications after gastrectomy adversely affect patient survival outcomes. To prevent gastric fluid leakage into the abdominal cavity, we developed a novel anastomosis method in which the stomach lumen is not opened (termed the non-opened clean end-to-end anastomosis method [NoCEAM]) and evaluated its feasibility.
MATERIALS AND METHODS
Subsequent to lymphadenectomy, the oral and anal resection lines were sutured using an intraoperative endoscope. After closing the stomach circumferentially with clips, the specimen was rolled outward like a "donut." We resected the specimen circumferentially using a linear stapler, and anastomosis was completed simultaneously. We examined the feasibility of this procedure ex vivo, using three porcine stomachs, and in vivo, using one pig. Subsequently, we applied the procedure to 13 consecutive patients with middle-third early gastric cancer utilizing laparotomic, laparoscopic, and robotic PPG.
RESULTS
NoCEAM was completed in all porcine models and human cases. In the human cases, the mean operation time (±standard deviation) was 279±51 minutes, and mean blood loss volume was 22±45 mL. The mean number of linear staples used was 5.06±0.76. None of the patients had complications, and all were discharged on the eighth postoperative. The serum total protein, serum albumin, and hemoglobin levels did not change significantly after surgery.
CONCLUSIONS
NoCEAM is feasible and safe for performing totally laparoscopic or robotic PPG. It may reduce postoperative complications, such as intra-abdominal infections.
PubMed: 37932220
DOI: 10.5230/jgc.2023.23.e33 -
Veterinary Research Communications Jun 2024The health of the gastrointestinal tract in cattle is one of the factors influencing adequate nutrient absorption and body weight gain. This study aimed to evaluate the...
The health of the gastrointestinal tract in cattle is one of the factors influencing adequate nutrient absorption and body weight gain. This study aimed to evaluate the prevalence of lesions found in the abomasum of Polish fattening Holstein-Friesian bulls. A total of 149 abomasa from adult bulls from two voivodeships of central Poland were inspected for pathologicalanatomic position (displacement, volvulus), impaction, mucosal membrane lesions (inflammation, hyperplasia), and signs of parasite infestation(Moroccan leather, worm nodules) in one of the Polish abattoirs just after slaughter. Among all the examined males no lesions were observed in only 8 individuals. The most common findings were erosions (75.8%) and type 1 ulcerations (48.3%) of the body, pylorus, or both locations. Signs of parasite infestations were observed in 78.5% of the inspected animals. Significant differences correlated with age were found in the prevalence of healed ulcers, and between voivodeships in the prevalence of type 2 ulcers. The findings of this study indicate that most fattening bulls in Poland suffer from subclinical forms of abomasa inflammation (both diffuse and focal) and middle-large abomasum parasites invasions, which can influence the economics and profitability, as well as welfare, of livestock production.
Topics: Animals; Cattle; Male; Poland; Abomasum; Cattle Diseases; Stomach Diseases; Prevalence
PubMed: 38539030
DOI: 10.1007/s11259-024-10366-4 -
Frontiers in Surgery 2024Gastric gastrointestinal stromal tumors in challenging anatomical locations are difficult to remove.
Robot-assisted laparoscopic combined with endoscopic partial gastrectomy (RALE-PG) for the treatment of gastric gastrointestinal stromal tumors in challenging anatomical locations: single-center experience.
BACKGROUND
Gastric gastrointestinal stromal tumors in challenging anatomical locations are difficult to remove.
METHODS
This study retrospectively analyzed the clinical data of 12 patients with gastric GISTs in challenging anatomical locations who underwent robot-assisted laparoscopic combined with endoscopic partial gastrectomy (RALE-PG) and manual suturing of the gastric wall.
RESULTS
This study included 12 patients with a mean age of 56.8 ± 9.8 years and a mean BMI of 23.9 ± 1.9 kg/m. Tumors were located in the GEJ ( = 3), lesser curvature ( = 3), posterior gastric wall ( = 3) and antrum ( = 3). The cardia and pylorus were successfully preserved in all patients regardless of the tumor location. The mean tumor size was 4.5 ± 1.4 cm. The mitotic-count/50 mm was less than 5 in all patients (100%). There was no intraoperative tumor rupture (0%) and no conversion to open surgery (0%). The median operation time was 122 (97-240) min, and the median blood loss volume was 10 (5-30) ml. The median postoperative VAS score was 2 (2-4). The median time to first flatus was 2 (2-3) days. The median time to first fluid intake was 2 (2-3) days. The median time to first ambulation after the operation was 3 (2-4) days. No cases of anastomotic stenosis or leakage were found. The median time to drain removal for 6 patients was 5 (4-7) days. The median time to nasogastric tube removal for all patients was 2 (1-5) days. The median postoperative hospital stay was 5 (4-8) days. One patient (female/41 year) developed moderate anemia (Clavien-Dindo grade II complication). There was no unplanned readmission within 30 days after the operation. The median distance from the tumor to the resection margin was 1 (1-2) cm. R0 resection was achieved in all patients. The median follow-up period was 19 (10-25) months, and all patients survived with no recurrence or metastasis.
CONCLUSIONS
RALE-PG is a safe, feasible and advantageous technique for treating GISTs in challenging anatomical locations. It can be used to accurately remove the tumor while preserving gastric function to the greatest extent, but long-term oncologic outcomes need to be evaluated in a study with a larger sample size and longer follow-up period.
PubMed: 38846924
DOI: 10.3389/fsurg.2024.1391387 -
Frontiers in Surgery 2024Periampullary neoplasm is rare in pediatric patients and has constituted a strict indication for pancreatoduodenectomy (PD), which is a procedure sporadically reported...
Periampullary neoplasm is rare in pediatric patients and has constituted a strict indication for pancreatoduodenectomy (PD), which is a procedure sporadically reported in the literature among children. Robotic PD has been routinely performed for periampullary neoplasm in periampullary neoplasm, but only a few cases in pediatric patients have been reported. Here, we report the case of a 3-year-old patient with periampullary rhabdomyosarcoma treated with robotic pylorus-preserving PD and share our experience with this procedure in pediatric patients. A 3-year-old patient presented with obstructive jaundice and a mass in the pancreatic head revealed by imaging. A laparoscopic biopsy was performed. Jaundice progressed with abdominal pain and elevated alpha-amylase leading to urgent robotic exploration in which a periampullary neoplasm was revealed and pathologically diagnosed as rhabdomyosarcoma by frozen section examination. After pylorus-preserving PD, we performed a conventional jejunal loop following a child reconstruction, including an end-to-end pancreaticojejunostomy, followed by end-to-side hepaticojejunostomy and duodenojejunostomy. Delayed gastric emptying (DGE) presented with increasing drain from the nasogastric tube (NGT) a week after the surgery and improved spontaneously within 10 days. In a 13-month follow-up until the present, our case patient recovered well without potentially fatal complications, such as pancreatic fistula. Robotic PD in pediatric patients was safe and effective without intra- or postoperative complications.
PubMed: 38440415
DOI: 10.3389/fsurg.2024.1284257 -
International Journal of Surgery Case... Mar 2024Gastric volvulus is an uncommon potentially life-threatening medical condition characterized by rotation of the stomach or part of the stomach around its longitudinal or...
INTRODUCTION AND IMPORTANCE
Gastric volvulus is an uncommon potentially life-threatening medical condition characterized by rotation of the stomach or part of the stomach around its longitudinal or transverse axis. Acute gastric volvulus usually presents with the triads of epigastric pain, nonproductive retching, and inability to pass the nasogastric tube. Diagnosis is assisted with abdominal and chest x-ray and contrast studies.
CASE PRESENTATION
A 53-year-old female presented with abdominal pain of two days duration which started at the epigastric region and later on became diffuse all over the abdomen. She had associated frequent episodes of vomiting which were initially bilious followed by nonproductive retching and low-grade intermittent fever. Abdominal examination showed a distended, diffusely tender abdomen with an ill-defined epigastric mass. Abdominal X-ray showed central abdominal circular opacity continuous with stomach outline. Intraoperative findings revealed perforated gangrenous mesenteroaxial gastric volvulus and splenopancreatic torsion with wandering spleen. Proximal subtotal gastrectomy with esophagogastric anastomosis and splenopexy was performed. The patient was discharged on the 10th postoperative day and had an uneventful post-operative recovery.
CLINICAL DISCUSSION
Primary gastric volvulus is usually mesenteroaxial with the pylorus commonly rotating anteriorly. Primary gastric volvulus can be associated with congenital asplenia and wandering spleen as both conditions are characterized by absent or loose ligamentous attachments. This case was a mesenteroaxial volvulus with splenopancreatic torsion with a wandering spleen caused by abnormal ligamentous attachments.
CONCLUSION
A high index of suspicion for early diagnosis of gastric volvulus and timely intervention is required to improve treatment outcome.
PubMed: 38308980
DOI: 10.1016/j.ijscr.2024.109338 -
Pediatric Surgery International Jun 2024We sought to determine the effectiveness and utility of two-dimensional shear-wave sonoelastography (2D-SW-SE) in the diagnosis and postoperative follow-up of infantile...
INTRODUCTION
We sought to determine the effectiveness and utility of two-dimensional shear-wave sonoelastography (2D-SW-SE) in the diagnosis and postoperative follow-up of infantile hypertrophic pyloric stenosis (IHPS).
MATERIALS AND METHODS
Twenty-three infants were included in the study, 13 in the IHPS group and 10 in the control group (CG). Preoperative B-mode ultrasonography measurements (longitudinal length and single-wall thickness of the pylorus) and 2D-SW-SE measurements (pylorus tissue stiffness and shear-wave propagation speed) were compared between the groups. The infants with IHPS then underwent Ramstedt pyloromyotomy and were invited for follow-ups on the tenth day and the first, third, and sixth months postoperatively. Measurements taken at the follow-ups were compared with the preoperative values.
RESULTS
No differences were found between the groups regarding age, gender, body weight, or week of birth. The pyloric lengths in the IHPS group were longer than in the CG (p < 0.001), and the single-wall thicknesses were thicker (p < 0.001). The pylorus in the IHPS group was four times stiffer than in the CG (27.4 kPa versus 7.66 kPa), and the shear-wave propagation speed in the tissue was higher (1.34 m/s versus 2.69 m/s; p < 0.001). Both values decreased over time in the IHPS group and were normal by the third postoperative month.
CONCLUSIONS
2D-SW-SE can be used as an assistive imaging tool alongside B-mode ultrasound for diagnosing IHPS. It can also be used to identify inadequate surgery by detecting whether the pyloric tissue has softened at follow-up.
Topics: Humans; Pyloric Stenosis, Hypertrophic; Elasticity Imaging Techniques; Male; Female; Infant; Follow-Up Studies; Infant, Newborn; Pylorus; Pyloromyotomy; Treatment Outcome
PubMed: 38916663
DOI: 10.1007/s00383-024-05738-5 -
Medicine Dec 2023Extensive endoscopic submucosal dissection (ESD) for gastric adenoma or early cancer can lead to post-ESD stenosis. This may cause a decrease in quality of life and an...
The efficacy of newly proposed gastric open peroral endoscopic myotomy (GO-POEM) in preventing post-endoscopic submucosal dissection stenosis: A comparison with non-GO-POEM group.
Extensive endoscopic submucosal dissection (ESD) for gastric adenoma or early cancer can lead to post-ESD stenosis. This may cause a decrease in quality of life and an increase in medical issues. Therefore, this study examined the safety and effectiveness of gastric open peroral endoscopic myotomy (GO-POEM) in preventing stenosis following ESD. A retrospective investigation was carried out on 31 patients who underwent gastric ESD for > 75% of the lumen in the antrum or pylorus at the Presbyterian Medical Center in Korea between December 2004 and October 2022. The patients were divided into GO-POEM (n = 11) and non-GO-POEM groups (n = 20). The average age of the 31 patients was 73.23 years, and 18 were male. There were no differences in age, sex, location, gross findings, or procedure time between the 2 groups. In the GO-POEM group, only 1 patient (9 %) developed stenosis, compared to 11 patients (55 %) in the control group (P = .02). Multivariate analysis showed that the GO-POEM group had a significantly lower risk of post-ESD stenosis (P < .05). Stenosis symptoms resolved with a single endoscopic balloon dilatation (EBD) in 1 patient in the GO-POEM group. In contrast, 5 of 11 patients with stenosis in the non-GO-POEM group required a median of 2 EBD sessions (range, 1-8). GO-POEM may be an effective and reliable method for preventing stenosis post extensive gastric ESD. Further investigations are necessary to establish its efficacy and safety.
Topics: Humans; Male; Aged; Female; Constriction, Pathologic; Endoscopic Mucosal Resection; Retrospective Studies; Quality of Life; Myotomy; Esophageal Achalasia; Treatment Outcome; Natural Orifice Endoscopic Surgery
PubMed: 38206733
DOI: 10.1097/MD.0000000000036755 -
Medicina (Kaunas, Lithuania) Aug 2023Foreign body ingestion is a frequently encountered emergency in healthcare institutions. It mostly affects pediatric populations, although it can also affect adults with...
Foreign body ingestion is a frequently encountered emergency in healthcare institutions. It mostly affects pediatric populations, although it can also affect adults with developmental delays, those with psychiatric diseases, drug abusers, and prisoners. Endoscopy is a diagnostic and treatment method for suspected foreign body ingestion. In this article, we discuss a 45-year-old tailor who swallowed a sewing pin while at work. The abdominal X-ray showed a needle-shaped metal shadow in the stomach region. During an upper endoscopy, it was discovered that a sewing pin with a sharp edge was stuck in the pylorus. The sewing pin was extracted endoscopically, and the patient was discharged the same day in good condition. Since the estimated risk of complications of foreign body ingestion in the adult population is about 35%, and the most common complications include impaction, laceration, bleeding, or perforation of the gastrointestinal wall, endoscopic or surgical removal is necessary. This also emphasizes the importance of a careful endoscopic evaluation of some at-risk occupations for foreign body ingestion with or without gastrointestinal complaints.
PubMed: 37763686
DOI: 10.3390/medicina59091566