Endoscopic Management of Weight Regain in the Bariatric Patient

Despite initial weight loss following bariatric surgery, weight recidivism is common. While weight regain is multifactorial and includes behavioral, psychosocial, and medical causes, changes in anatomy also play a role. Dilation of the gastrojejunal anastomosis following Roux-en-Y gastric bypass and enlargement of the gastric sleeve following sleeve gastrectomy are both important considerations. Historically, surgical revision has been performed to address weight regain; however, morbidity and mortality are not insignificant. Over the past decade, a variety of endoscopic approaches have been described for weight recidivism, several of which have proven to be safe, effective, and durable. This article will review each of these techniques in detail.

Management of gastrojejunostomy leakage after emergency gastrectomy

Ulcer perforation remains a life-threatening disease, which can be treated in several surgical approaches, however in some cases an emergency gastrectomy is the only option. Emergency gastrectomy has been associated to high morbidity and local mortality rates, namely systemic complications, such as, duodenal stump leak, gastrojejunostomy leakage and intra-abdominal collections. The treatment of gastrojejunostomy leakage, is still generating controversy, despite nowadays, the conservative approach is preferred. We present a clinical case of a 62-years-old male patient, in which a gastrojejunal leakage occurred, after emergency gastrectomy due to an ulcer perforation. Computed tomography of the abdomen did reveal peritoneal liquid near duodenal stump and gastrojejunostomy with no oral extravasation. At 24th post-operatory day, the patient deteriorated and we decided to perform a laparotomy exploration. Identified and treated, 2 small leakages (6 mm each), on the anterior face of the gastrojejunal anastomosis, using directed fistulization with Pezzer catheters. The patient was kept under total parenteral nutrition followed by enteral feeding and anti-microbial therapeutic. At the consultation, Radiography with oral contrast and Computed Tomography Scan with intravenous and oral contrast showed no evidence of anastomotic leak or abscesses, showing the success of this therapeutic approach.