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Current Diabetes Reports Mar 2023Although bariatric surgery is the most effective treatment of severe obesity, a proportion of patients experience clinically significant weight regain (WR) with further... (Review)
Review
PURPOSE OF REVIEW
Although bariatric surgery is the most effective treatment of severe obesity, a proportion of patients experience clinically significant weight regain (WR) with further out from surgery. The purpose of this review is to summarize the prevalence, predictors, and causes of weight regain.
RECENT FINDINGS
Estimating the prevalence of WR is limited by a lack of consensus on its definition. While anatomic failures such as dilated gastric fundus after sleeve gastrectomy and gastro-gastric fistula after Roux-en-Y gastric bypass can lead to WR, the most common causes appear to be dysregulated/maladaptive eating behaviors, lifestyle factors, and physiological compensatory mechanisms. To date, dietary, supportive, behavioral, and exercise interventions have not demonstrated a clinically meaningful impact on WR, and there is limited evidence for pharmacotherapy. Future studies should be aimed at better defining WR to begin to understand the etiologies. Additionally, there is a need for non-surgical interventions with demonstrated efficacy in rigorous randomized controlled trials for the prevention and reversal of WR after bariatric surgery.
Topics: Humans; Weight Gain; Retrospective Studies; Bariatric Surgery; Obesity; Obesity, Morbid; Gastric Bypass
PubMed: 36752995
DOI: 10.1007/s11892-023-01498-z -
Journal of Thoracic Disease Jul 2020Airway-gastric fistulas (AGFs) are rare but life-threatening complications after esophagectomy for esophageal cancer. Their effective and reasonable management is...
BACKGROUND
Airway-gastric fistulas (AGFs) are rare but life-threatening complications after esophagectomy for esophageal cancer. Their effective and reasonable management is challenging and still controversial. This study reports the classification and management strategies of post-esophagectomy AGF based on a retrospective analysis of 26 cases in two large volume centers in China.
METHODS
Between January 2000 and December 2017, 6,316 consecutive patients with esophageal carcinoma underwent esophagectomy. AGF was verified in 26 patients. The patients with AGF were divided into two types based on the anatomic characteristics of the fistula. Type I was characterized by the presence of fistula orifices in digestive tract that were higher than those in the airway and were treated with conservative management. Type II had both fistula orifices located on the same horizontal plane and were treated with surgical management. Pearson Chi-Square (R software) was used to compare mortality rates.
RESULTS
From January 2000 and December 2017, 26 cases occurred AGF in 6,316 consecutive patients with esophageal carcinoma underwent esophagectomy and the incidence of AGF was 0.4%. Ten of 12 patients with type I AGF survived. Nine of 14 patients with type II AGF died. There was a significantly difference in the mortality rates between patients with AGF type I and II, which was 16.7% (2/12) and 64.3% (9/14) (χ=6.003, P=0.014), respectively.
CONCLUSIONS
AGF may be classified into two types according to the anatomic characteristics. Type I patients may be cured by conservative management and type II patients, require surgical intervention with pedicled tissues flap wrapping of the airway.
PubMed: 32802439
DOI: 10.21037/jtd-20-284 -
BMJ Case Reports Sep 2018
Topics: Aged; Analgesics, Non-Narcotic; Asthma; Back Pain; Duodenal Diseases; Endoscopy; Gastric Fistula; Gastrointestinal Hemorrhage; Humans; Ibuprofen; Laparotomy; Ligation; Male; Peptic Ulcer; Prednisone; Pylorus; Treatment Outcome
PubMed: 30181403
DOI: 10.1136/bcr-2018-225850 -
Journal of Visceral Surgery Oct 2018
Topics: Anastomotic Leak; Gastric Bypass; Gastric Fistula; Humans; Postoperative Complications; Risk Factors; Tomography, X-Ray Computed
PubMed: 30093308
DOI: 10.1016/j.jviscsurg.2018.07.008 -
International Journal of Surgery Case... Feb 2021Postsleeve gastrectomy fistula is a serious complication, and its management remains quite challenging. The clinical presentation of chronic fistula after sleeve...
INTRODUCTION
Postsleeve gastrectomy fistula is a serious complication, and its management remains quite challenging. The clinical presentation of chronic fistula after sleeve gastrectomy (SG) varies widely and depends on the type of fistula. Management requires a multidisciplinary approach and patient cooperation.
CASE PRESENTATION
We present a case of a 41-year-old woman with a body mass index (BMI) of 46 kg/m who initially underwent laparoscopic sleeve gastrectomy in our hospital. Later, she developed a gastro-colo-diaphragmatic fistula (GCD), which was successfully treated using an endolaparoscopic approach. Follow-up imaging and endoscopy showed complete healing of the fistula, as well as a marked clinical improvement of the patient.
DISCUSSION
Gastro-colo-diaphragmatic fistula following sleeve gastrectomy is an extremely rare complication. This is the first case of a GCD fistula after sleeve gastrectomy that has been reported in the literature.
CONCLUSION
One staged endolaparoscopic management was successful approach in our case and can be considered for complex gastric fistula following sleeve gastrectomy.
PubMed: 33517211
DOI: 10.1016/j.ijscr.2021.01.083 -
Gastrointestinal Endoscopy Clinics of... Jan 2020Endoscopic suturing allows for select patients with perforations, leaks, and fistulas to be managed endoscopically. Experience with the Overstitch endoscopic suturing... (Review)
Review
Endoscopic suturing allows for select patients with perforations, leaks, and fistulas to be managed endoscopically. Experience with the Overstitch endoscopic suturing device suggests it may be superior to endoclips in the management of perforations, because of its ability to achieve full-thickness suturing and create an airtight closure. Although successful closure of leaks and fistulas using the Overstitch device has been described, additional therapy with a multimodality approach is often required because of inherent challenges with fistula recurrence. This article reviews the existing literature on the Overstitch endoscopic suturing system specifically in the management of gastrointestinal perforations, leaks, and fistulas.
Topics: Endoscopy, Gastrointestinal; Gastric Fistula; Gastrointestinal Tract; Humans; Intestinal Fistula; Intestinal Perforation; Suture Techniques; Treatment Outcome
PubMed: 31739961
DOI: 10.1016/j.giec.2019.08.010 -
Postgraduate Medical Journal Aug 19741. Gastro-bronchial fistula is a rare condition occurring most commonly as a complication of a subphrenic abscess. 2. Other causes include trauma and necrosis within an...
1. Gastro-bronchial fistula is a rare condition occurring most commonly as a complication of a subphrenic abscess. 2. Other causes include trauma and necrosis within an infiltrating neoplasm. 3. The treatment of those fistulae which are secondary to a subphrenic abscess should be by drainage of the abscess, jejunal tube feeding and continuous gastric aspiration.
Topics: Aged; Bronchial Fistula; Gastric Fistula; Humans; Male; Pancreatic Neoplasms; Radiography
PubMed: 4464513
DOI: 10.1136/pgmj.50.586.504 -
Arquivos Brasileiros de Cirurgia... 2015Gastric bypass is today the most frequently performed bariatric procedure, but, despite of it, several complications can occur with varied morbimortality. Probably all... (Review)
Review
INTRODUCTION
Gastric bypass is today the most frequently performed bariatric procedure, but, despite of it, several complications can occur with varied morbimortality. Probably all bariatric surgeons know these complications, but, as bariatric surgery continues to spread, general surgeon must be familiarized to it and its management. Gastric bypass complications can be divided into two groups: early and late complications, taking into account the two weeks period after the surgery. This paper will focus the late ones.
METHOD
Literature review was carried out using Medline/PubMed, Cochrane Library, SciELO, and additional information on institutional sites of interest crossing the headings: gastric bypass AND complications; follow-up studies AND complications; postoperative complications AND anastomosis, Roux-en-Y; obesity AND postoperative complications. Search language was English.
RESULTS
There were selected 35 studies that matched the headings. Late complications were considered as: anastomotic strictures, marginal ulceration and gastrogastric fistula.
CONCLUSION
Knowledge on strategies on how to reduce the risk and incidence of complications must be acquired, and every surgeon must be familiar with these complications in order to achieve an earlier recognition and perform the best intervention.
Topics: Gastric Bypass; Gastric Fistula; Humans; Postoperative Complications; Time Factors; Ulcer
PubMed: 26176254
DOI: 10.1590/S0102-67202015000200014 -
The Journal of International Medical... Nov 2019Gastric teratoma primarily occurs within 3 months following birth, and is a rare pattern of gastric lesion in adult patients. The present study reports the case of a... (Review)
Review
Gastric teratoma primarily occurs within 3 months following birth, and is a rare pattern of gastric lesion in adult patients. The present study reports the case of a 60-year-old male patient who was diagnosed with a tumour in the lesser curvature within the gastric cardia area, which grew outside the cavity, invaded into the duodenal bulb and formed a gastroduodenal fistula. Briefly, initial gastroscopy upon hospital admission revealed mucosa bulging into the gastric cavity, gastric ulcer and duodenal bulb mucosal congestion with oedema. Subsequent computed tomography scans showed lesser curvature-occupying hamartoma in the gastric cardia area, and upper gastrointestinal angiography confirmed gastric stromal tumour complicated with cardia duodenal fistula. Total gastrectomy followed by Roux-en-y oesophagojejunostomy was performed, and pathology analysis of the tissue specimen confirmed mature gastric teratoma. The formation of a gastroduodenal bulb fistula with the tumour as a bridge is a rare phenomenon. A notable finding of the present case study was that the final diagnosis of gastric teratoma mainly depended on pathological examination.
Topics: Adult; Angiography; Gastric Fistula; Humans; Male; Middle Aged; Neoplasm Invasiveness; Stomach Neoplasms; Teratoma; Tomography, X-Ray Computed
PubMed: 31558072
DOI: 10.1177/0300060519869722 -
Medicine Nov 2019Mucormycosis is a rare opportunistic fungal infection with poor prognosis. The incidence of mucormycosis has been increasing, and it is a threat to immunocompromised... (Review)
Review
RATIONALE
Mucormycosis is a rare opportunistic fungal infection with poor prognosis. The incidence of mucormycosis has been increasing, and it is a threat to immunocompromised hosts. We present a case of gastric mucormycosis complicated by a gastropleural fistula during immunosuppressive treatment for adult-onset Still disease (AOSD).
PATIENT CONCERNS
An 82-year-old woman diagnosed with AOSD who developed gastric ulcers during the administration of an immunosuppressive therapy with corticosteroids, cyclosporine, and tocilizumab complained of melena and epigastralgia. Esophagogastroduodenoscopy showed multiple ulcers covered with grayish or greenish exudates.
DIAGNOSES
The patient diagnosed with mucormycosis based on culture and biopsy of the ulcers, which showed nonseptate hyphae branching at wide angles. Mucor indicus was identified using polymerase chain reaction.
INTERVENTIONS AND OUTCOMES
Although liposomal amphotericin B was administered, gastric mucormycosis was found to be complicated by a gastropleural fistula. The patient died because of pneumonia due to cytomegalovirus infection, and autopsy revealed the presence of Mucorales around the fistula connecting the stomach and diaphragm.
LESSONS
Gastric mucormycosis is refractory to treatment and fatal. Surgical resection, if possible, along with antifungal drugs can result in better outcomes.
Topics: Aged, 80 and over; Female; Gastric Fistula; Humans; Immunosuppressive Agents; Mucormycosis; Opportunistic Infections; Pleura; Respiratory Tract Fistula; Still's Disease, Adult-Onset; Stomach Ulcer
PubMed: 31770250
DOI: 10.1097/MD.0000000000018142