scholarly journals Functional Laparoscopic Roux-en-Y Gastric Bypass with Fundectomy and Gastric Remnant Exploration (LRYGBfse)—a Video Vignette

2021 ◽  
Vol 31 (5) ◽  
pp. 2350-2352
Author(s):  
Giovanni Lesti ◽  
Marco Antonio Zappa ◽  
Francesco Lesti ◽  
Davide Bona ◽  
Alberto Aiolfi
Keyword(s):  
Gastric Bypass ◽  
Gastric Wall ◽  
Gastric Pouch ◽  
Gastric Remnant ◽  
Easy Access ◽  
Excluded Stomach ◽  
Biliopancreatic Limb ◽  
Safe Technique ◽  
A New Technique ◽  
Video Vignette

Abstract Background The laparoscopic Roux en-Y gastric bypass (LRYGB) is performed worldwide and is considered by many the gold standard treatment for morbid obesity. However, the difficult access to the gastric remnant and duodenum represents intrinsic limitations. The functional laparoscopic gastric bypass with fundectomy and gastric remnant exploration (LRYGBfse) is a new technique described in attempt to overcome the limitations of the LRYGB. The purpose of this video was to demonstrate the LRYGBfse in a 48-year-old man with type II diabetes and hypertension. Methods An intraoperative video has been anonymized and edited to demonstrate the feasibility of LRYGBfse. Results The operation started with the opening of the gastrocolic ligament. Staying close to the gastric wall, the stomach is prepared up to the angle of His. After the placement of a 36-Fr orogastric probe, gastric fundectomy is completed in order to create a 30cc gastric pouch. A polytetrafluoroethylene banding (ePTFE) is placed at the gastro-gastric communication, 7cm below the cardia, and gently closed after bougie retraction. The bypass is completed by the creation of an antecolic Roux-en-Y 150cm alimentary and 150cm biliopancreatic limb. Conclusion The LRYGBfse is a feasible and safe technique. The possibility to endoscopically explore the excluded stomach with an easy access to the Vater’s papilla is a major advantage. Further studies are warranted to deeply explore and compare outcomes with the standard LRYGB.

Early gastrogastric fistula after Roux-en-Y gastric bypass: successful fistula treatment with self-expandable endoscopic stent

2021 ◽  
Vol 14 (6) ◽  
pp. e243748
Author(s):  
Julian Süsstrunk ◽  
Miriam Thumshirn ◽  
Ralph Peterli ◽  
Marko Kraljević
Keyword(s):  
Gastric Bypass ◽  
Gastric Bypass Surgery ◽  
Rare Complication ◽  
Gastric Pouch ◽  
Gastric Remnant ◽  
Metal Stent ◽  
Endoscopic Stent ◽  
Gastrogastric Fistula ◽  
Laparoscopic Drainage ◽  
Fistula Treatment

A 25-year-old patient underwent laparoscopic Roux-en-Y gastric bypass surgery with an initially uneventful postoperative course. Two weeks postoperatively, the patient presented with acute abdominal pain. CT scan revealed a gastrogastric fistula from the gastric pouch to the gastric remnant. Laparoscopic drainage was performed, and intraoperative endoscopy confirmed a large gastrogastric fistula. Due to intense adhesions between pouch and remnant, a closure by suture of the fistula was not possible. The fistula was initially treated with a fully covered metal stent. After multiple stent migrations despite clip attachment to the mucosa, the stent was changed to a partially covered metal stent. Fistula healing progress was documented every 2 weeks. After 10 weeks of stent treatment, fistula closure was accomplished.In conclusion, early fistula from the gastric pouch to the gastric remnant is a rare complication and can be managed with endoscopic stent placement.

Surgical Technique of Diverted One-Anastomosis Gastric Bypass

2021 ◽  
Vol 39 ◽  
Author(s):  
Daniel Felsenreich ◽  
◽  
Felix Langer ◽  
Christoph Bichler ◽  
Jakob Eichelter ◽  
...  
Keyword(s):  
Weight Loss ◽  
Gastric Bypass ◽  
Surgical Technique ◽  
Gastric Pouch ◽  
One Anastomosis Gastric Bypass ◽  
Postoperative Course ◽  
Desirable Outcome ◽  
Bariatric Metabolic Surgery ◽  
Induce Weight Loss ◽  
Biliopancreatic Limb

Laparoscopic diverted one-anastomosis gastric bypass (D-OAGB) is a bariatric procedure combining the principles of restriction, malabsorption, and other factors to induce weight loss. It is achieved by creating a narrow, long gastric pouch and bypassing a part of the small bowel (biliopancreatic limb). D-OAGB was first described by Dr. Ribero in 2013 and is technically a variation of the very heterogeneous group of Roux-en-Y gastric bypass operations. There are different technical variants to perform D-OAGB and to organize pre- and postoperative care. The following article is based on the approach to bariatric surgery as taken at the Department of General Surgery at the Medical University of Vienna. This article focuses on patient preparation before bariatric/metabolic surgery with mandatory and optional preoperative examinations to find the surgical procedure best suited for each individual patient and to decrease the patient’s risk. The surgical technique of D-OAGB itself, including positioning of the patient and related technical highlights, as well as the specifics of the postoperative course, are described. D-OAGB is an effective procedure for patients with symptomatic gastroesophageal reflux for adequate weight loss and remission of comorbidities with a low risk of malnutrition. For D-OAGB to be successful, important technical steps, such as creating a narrow, long pouch, exact length of the biliopancreatic and alimentary limb, and additional hiatoplasty (if necessary), should be taken. In terms of the postoperative course, regular checkups are vital to ensure desirable outcome in the long-term follow up and early detection of adverse developments.

Laparoscopic Transgastric Endoscopy after Roux-en-Y Gastric Bypass: Case Series and Review of the Literature

2012 ◽  
Vol 78 (10) ◽  
pp. 1182-1186 ◽  
Author(s):  
Jason F. Richardson ◽  
John G. Lee ◽  
Brian R. Smith ◽  
Brian Nguyen ◽  
Kathleen P. Pham ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Case Series ◽  
Biliary Tree ◽  
Gastric Remnant ◽  
Endoscopic Retrograde ◽  
Biliary Cannulation ◽  
Medical Centers ◽  
Excluded Stomach ◽  
History Of

Endoscopic access to the gastric remnant and pancreatobiliary tree is technically difficult after Roux-en-Y gastric bypass even when facilitated by the use of specialized techniques such as balloon enteroscopy and the use of overtubes. Furthermore, such techniques are not universally available at all medical centers. We describe a case series of 13 patients with a history of Roux-en-Y gastric bypass for the treatment of morbid obesity who underwent laparoscopic transgastric endoscopy through the gastric remnant to access the duodenum or biliary tree. Charts of these patients were reviewed for demographics, indications for procedure, length of stay, morbidity, and mortality. Four of the patients had failed prior attempts to access the excluded anatomy through traditional transoral endoscopy. Two patients underwent transgastric endoscopy for evaluation of gastrointestinal bleeding. Of the 11 patients for whom endoscopic retrograde cholangiopancreatography was planned, all underwent successful biliary cannulation and sphincterotomy. There were no conversions to an open procedure or complications during the follow-up period. Laparoscopic transgastric endoscopy is a safe and reliable method to access the excluded stomach and biliary tree in patients with a history of Roux-en-Y gastric bypass.

scholarly journals Gastric Pouch Mixed Adenoneuroendocrine Carcinoma With a Mixed Adenocarcinoma Component After Roux-en-Y Gastric Bypass

2017 ◽  
Vol 5 (4) ◽  
pp. 232470961774090 ◽  
Author(s):  
Ricardo G. Pastorello ◽  
Mariana Petaccia de Macedo ◽  
Wilson Luiz da Costa Junior ◽  
Maria Dirlei F. S. Begnami
Keyword(s):  
Bariatric Surgery ◽  
Gastric Bypass ◽  
Gastric Pouch ◽  
Unique Case ◽  
Rare Type ◽  
Mixed Adenoneuroendocrine Carcinoma ◽  
Early Cancer Diagnosis ◽  
Excluded Stomach ◽  
Cell Components ◽  
Adenocarcinoma Component

The Roux-en-Y gastric bypass is one of the most common procedures currently performed for surgical treatment of patients with severe obesity. Gastric cancer after bariatric surgery is not common, with most of them arising in the excluded stomach. Gastric mixed adenoneuroendocrine carcinomas are a rare type of stomach malignancy, composed of both adenocarcinoma and neuroendocrine tumor-cell components, with the latter comprising at least 30% of the whole neoplasm. In this article, we report a unique case of a mixed adenoneuroendocrine carcinoma with a mixed adenocarcinoma (tubular and poorly cohesive) component arising in the gastric pouch of a patient who underwent previous Roux-en-Y gastric bypass for glycemic control. Since stomach cancer is not usual in patients who have formerly undergone bariatric surgery and symptoms tend to be nonspecific, such diagnosis is often rendered at an advanced stage. Full assessment of these patients when presenting such vague symptoms is critical for an early cancer diagnosis.

scholarly journals Robotic Roux-en-Y gastric bypass: operative results in 100 patients

2014 ◽  
Vol 27 (suppl 1) ◽  
pp. 9-12 ◽  
Author(s):  
Carlos Eduardo DOMENE ◽  
Paula VOLPE ◽  
Frederico A. HEITOR
Keyword(s):  
Morbid Obesity ◽  
Gastric Bypass ◽  
Gastric Pouch ◽  
The Body ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Super Obese ◽  
Robotic Gastric Bypass ◽  
Operative Complications ◽  
Biliopancreatic Limb

BACKGROUND: Laparoscopic gastric bypass is gold-standard for morbid obesity treatment. AIM: To describe the results of robotic gastric bypass for morbid obesity patients. METHOD: Were operated on 100 morbidly obese patients through totally robotic gastric bypass between 2013 and 2014. They were 83% female. The age ranged from 20 to 65 years old (medium 48,5 years); the body mass index varied between 38-67 (medium 42,3 kg/cm2). The procedure was designed with 3 cm long gastric pouch, 1 m biliopancreatic limb, 1,2 m alimentary limb, manual or stapled anastomosis. There were four super-super-obese patients and four revisional surgeries. RESULTS: Docking time varied from 1 to 20 min (medium 4 min). Console time varied from 40-185 min (medium 105 min). There were no intra operative complications or mortality. There were two lower limb deep venous thrombosis. There was no readmission in the first 30 days. CONCLUSION: Totally robotic gastric bypass is safe and reproduceable, with excellent results even during the initial experience with regular surgeries, revisional surgeries or in super-obese patients. Adequate training may shortens or obviates the learning curve.

scholarly journals Percutaneous Gastrostomy Placement for Decompression of the Excluded Gastric Remnant following Roux-en-Y Gastric Bypass Surgery

2018 ◽  
Vol 02 (03) ◽  
pp. 144-148
Author(s):  
Shamaita Majumdar ◽  
Tatulya Tiwari ◽  
Olaguoke Akinwande ◽  
Raja Ramaswamy
Keyword(s):  
Gastric Bypass ◽  
Clinical Success ◽  
Gastric Bypass Surgery ◽  
Catheter Placement ◽  
Gastric Remnant ◽  
Percutaneous Gastrostomy ◽  
Presenting Symptoms ◽  
Excluded Stomach ◽  
Bypassed Stomach ◽  
Predominantly Female

Abstract Purpose To evaluate the feasibility and safety of percutaneous gastrostomy for decompression of the excluded stomach in patients’ status post Roux-en-Y gastric bypass (RYGB). Materials and Methods Between January 2001 and August 2017, 10 consecutive RYGB patients who underwent placement of a decompressive gastrostomy of the excluded stomach were identified in an institutional database. Technical success was defined as successful gastrostomy catheter placement in the bypassed stomach using fluoroscopy and/or ultrasound guidance. Clinical success was established if dilation of the excluded stomach improved after gastrostomy with resolution of associated symptoms. Charts were reviewed for treatment-related adverse events post-procedure. Results The cohort was predominantly female (9/10), with an average age of 54 ± 14 years. Median follow-up was 35.2 months (range: 0.6–115). Indications for decompressive gastrostomy placement included small bowel obstruction (6/10) or afferent limb obstruction at the jejunojejunal anastomosis (4/10). The most common presenting symptoms were abdominal pain, distension, and vomiting. All patients had successful gastrostomy placement in the excluded remnant, using ultrasound and fluoroscopic guidance, with no procedural complications. The 12 to 16F Cope loop catheters was used in this cohort, and gastropexy sutures were used in two cases. All 10 patients demonstrated clinical resolution of symptoms after gastrostomy placement. Two patients developed minor complications of tube site leakage and poor tube function requiring gastrostomy exchange within 1 week of the procedure. Conclusion Fluoroscopic and ultrasound-guided percutaneous gastrostomy catheter placement is a safe, effective, and feasible approach to treating dilation of the excluded gastric remnant in RYGB patients.

Endoscopic ultrasound-guided creation of a transgastric fistula for the management of hepatobiliary disease in patients with Roux-en-Y gastric bypass

Endoscopy ◽  
2017 ◽  
Vol 49 (06) ◽  
pp. 549-552 ◽  
Author(s):  
Saowanee Ngamruengphong ◽  
Jose Nieto ◽  
Rastislav Kunda ◽  
Vivek Kumbhari ◽  
Yen-I Chen ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Argon Plasma Coagulation ◽  
Gastric Pouch ◽  
Argon Plasma ◽  
Metal Stents ◽  
Ultrasound Guided ◽  
Endoscopic Closure ◽  
Excluded Stomach

Abstract Background and aims Endoscopic retrograde cholangiopancreatography (ERCP) in patients who have undergone Roux-en-Y gastric bypass (RYGB) is technically challenging. We describe our multicenter experience using lumen-apposing metal stents (LAMSs) to create an endoscopic ultrasound-guided transgastric fistula (EUS-TG) to facilitate peroral ERCP in these patients. Patients and methods Thirteen patients with RYGB who underwent EUS-TG at three tertiary centers were included. EUS was used to guide puncture of the excluded stomach from the gastric pouch or jejunum; a LAMS was placed across the transgastric fistula. ERCP was performed via a duodenoscope passed through the LAMS. Results The technical success of EUS-TG was 100 % (13/13). ERCP through the LAMS was successful and clinical success was achieved in all patients. LAMS dislodgement during ERCP occurred in two patients and the stent was successfully repositioned without sequelae. After removal of the LAMS, the fistula was closed in 92 % of patients, either by endoscopic closure devices or argon plasma coagulation. None of the patients experienced procedure-related adverse events. Conclusion EUS-TG is an effective and safe method of accessing the excluded stomach and performing ERCP in patients with RYGB.

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