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

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.

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Emergency laparoscopic partial resection of the excluded stomach and gastric pouch in a gastric bypass patient with acute gastrogastric fistula bleeding

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2019.11.016 ◽

2020 ◽

Vol 16 (3) ◽

pp. 445-446

Author(s):

Jad M. Abdelsattar ◽

Ian L. McCulloch ◽

Salim Abunnaja

Keyword(s):

Gastric Bypass ◽

Gastric Pouch ◽

Partial Resection ◽

Gastric Bypass Patient ◽

Gastrogastric Fistula ◽

Excluded Stomach ◽

Bypass Patient

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

Obesity Surgery ◽

10.1007/s11695-021-05298-w ◽

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.

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P140 LAPAROSCOPIC MODIFIED BELSEY TYPE FUNDOPLICATION FOR REFLUX AFTER ROUX Y GASTRIC BYPASS – A POTENTIAL SAVIOR WHEN THE SAVIOR IS IN TROUBLE!

Diseases of the Esophagus ◽

10.1093/dote/doz092.140 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

Al Saadi Hatem ◽

Raza Syed ◽

Sharples Alistair ◽

Rao Vittal ◽

Nagammapudur Balaji

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Gastric Bypass ◽

Hiatal Hernia ◽

Gastric Pouch ◽

Revisional Bariatric Surgery ◽

Barium Swallow ◽

Hiatal Hernia Repair ◽

Co Morbidity ◽

Patient Reported

Abstract Background Roux Y Gastric Bypass (RYGB) is the preferred primary bariatric surgical option in patients with preoperative gastro oesophageal reflux disease (GERD). It is also the preferred revisional bariatric surgery after when GERD develops after an alternate primary bariatric surgery. However reflux after RYGB although uncommon can present due to a variety of factors. Management can be challenging. Aim/Hypothesis A modified version of the Belsey IV fundoplication can be done laparoscopically to reconstitute the antireflux barrier in the absence of a Fundal remnant in the gastric pouch after RYGB. Methods We present a single patient experience/case study where there was evidence of recurrent GERD in spite of a successful RYGB in terms of weight loss and comorbidity resolution. A 42 year old female with a BMI > 40 and metabolic co-morbidities and GERD was deemed fit for RYGB. After a technically uneventful RYGB with standard limb lengths ( Roux 120cms and BP limb 70 cms) there was significant weight loss ( > 70% EBWL) and co-morbidity resolution. However her symptoms of GERD persisted. An gastroscopy confimed esophagitis and a barium swallow showed evidence of GERD with a small hiatal hernia and a 3-4 cms Candy cane limb. There was no evidence of a gastrogastric fistula. Revisonal surgery was done which revealed no significant candy cane limb. A small (<2cms) hiatal hernia was found. Complete esophageal mobilization and a hiatal hernia repair was done in a standard fashion. Furthermore the anterior wall of the long gastric pouch was invaginated to obtain an approximate coverage of 200 degrees in a single layer Belsey technique. The procedure was completed laparoscopically. Results The post-operative period was uneventful. Patient reported complete absence of reflux after surgery and remains off PPI in the short term. Temporary dysphagia was noticed in the first few weeks after surgery which improved with expectant treatment. Conclusion A Laparoscopic modified Belsey type fundoplication serves as an effective method to treat GERD after a RYGB if other potential causes of GERD are excluded.

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Gastric Cancer in the Excluded Stomach 10 Years after Gastric Bypass

Case Reports in Surgery ◽

10.1155/2015/468293 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Augusto Tinoco ◽

Lorena F. Gottardi ◽

Eduardo D. Boechat

Keyword(s):

Gastric Cancer ◽

Bariatric Surgery ◽

Gastric Bypass ◽

Gastric Adenocarcinoma ◽

Rare Condition ◽

Gastric Lesions ◽

Common Cause ◽

Health Authorities ◽

Excluded Stomach ◽

Related Mortality

According to the Brazilian health authorities, around 2,000 new cases of gastric cancer emerge in Brazil per year (Instituto Nacional de Câncer José Alencar Gomes da Silva, 2014). Indeed, gastric cancer constitutes the second most common cause of cancer-related mortality worldwide and 95% of such malignancies are adenocarcinomas (De Roover et al., 2006, and Clark et al., 2006). Roux-en-Y gastric bypass (RYGB) is a procedure frequently employed in bariatric surgery but restricted access to the excluded stomach means that discovery of gastric lesions is difficult, and diagnosis and treatment may be delayed. We report herein a case of gastric adenocarcinoma in the excluded stomach of a patient submitted to RYGB with the purpose of illustrating the difficulty of diagnosing and treating this rare condition.

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Surgical Management of a Caustic Ingestion in a Gastric Bypass Patient: A Case Report

Austin Journal of Surgery ◽

10.26420/austinjsurg.2021.1266 ◽

2021 ◽

Vol 8 (2) ◽

Author(s):

Van Boxstael E ◽

◽

Terwagne N ◽

Deswysen Y ◽

◽

...

Keyword(s):

Bariatric Surgery ◽

Gastric Bypass ◽

Suicide Attempt ◽

Surgical Management ◽

Gastric Pouch ◽

Psychological Disorders ◽

Exploratory Laparotomy ◽

Caustic Ingestion ◽

Alimentary Limb ◽

Gastric Bypass Patient

Introduction: Bariatric surgery is recognized as the most effective treatment for obesity. Increased rate of psychological disorders has been noted after surgery. However, no case of caustic ingestion after bariatric surgery and its surgical management has been reported in the literature. Presentation of Case: A 48-year-old woman, who underwent a Rouxen- Y gastric bypass 9 years ago, ingested caustic substances as a suicide attempt, causing necrosis of the entire alimentary limb without severe lesion of esophageal tract or gastric pouch. During exploratory laparotomy, resection of the alimentary limb and gastrostomy in the neogastric pouch were performed. Three months later, the patient presented to the emergency room with a dislodged gastrostomy tube. Exploratory laparotomy was performed with restoration of anatomical continuity via gastro-gastric anastomosis. Discussion: Bariatric surgery is correlated to a higher postoperative risk of psychological disorders until suicide attempt. This case is the first description of caustic ingestion after Roux-en-Y gastric bypass and its surgical management. It underlines the importance for bariatric teams to consider psychological aspect of surgical patients pre- and postoperatively.

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

Endoscopy ◽

10.1055/s-0043-105072 ◽

2017 ◽

Vol 49 (06) ◽

pp. 549-552 ◽

Cited By ~ 31

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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