RESUMEN
Endoscopic sleeve gastroplasty (ESG) has emerged as a safe and effective treatment for obesity over the past decade. This procedure, however, is technically challenging and requires frequent troubleshooting, even among experts. In this article the authors discuss current techniques, common pitfalls and adverse outcomes associated with ESG, how to avoid them, and how to address them if they occur.
Asunto(s)
Gastroplastia , Humanos , Gastroplastia/métodos , Gastroplastia/instrumentación , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/etiología , Gastroscopía/métodos , Gastroscopía/instrumentaciónRESUMEN
With the growing global burden of obesity, the field of endobariatrics has emerged as a promising alternative, filling the void between lifestyle interventions with modest efficacy and more invasive surgical procedures. This article explores the latest advancements in endobariatric therapies, encompassing endoscopic sleeve gastroplasty (ESG), intragastric balloons (IGB), endoscopic metabolic therapies, and promising pharmacologic and surgical combination approaches that integrate multiple therapeutic modalities. It also outlines the critical factors and strategic considerations necessary for the successful integration of endobariatric interventions into clinical practice.
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Cirugía Bariátrica , Humanos , Cirugía Bariátrica/métodos , Cirugía Bariátrica/instrumentación , Obesidad/cirugía , Obesidad/terapia , Balón Gástrico , Gastroplastia/métodos , Gastroplastia/instrumentación , Endoscopía Gastrointestinal/métodos , Endoscopía Gastrointestinal/instrumentación , Endoscopía Gastrointestinal/tendenciasRESUMEN
BACKGROUND: Laparoscopic paraesophageal hernia (PEH) repair has a high hernia recurrence rate. The aim of this study was to assess the 5-year hernia recurrence rate after PEH repair using a combination of bioresorbable mesh and advanced surgical techniques to address tension as needed in a prospective group of patients. STUDY DESIGN: In 2016, a prospective database was established for 50 patients undergoing primary, elective PEH repair with a new bioresorbable mesh (Phasix ST). Intraoperatively, tension was addressed with Collis gastroplasty and diaphragm relaxing incisions as needed. All 50 patients from the initial study were tracked and asked to return for objective follow-up. Recurrence was considered present for any hernia more than 2 cm in size. RESULTS: Objective follow-up was conducted in 27 of the original 50 (54%) patients at a median of 5.25 years after their PEH repair. Before the 5-year follow-up, 5 patients had a known recurrent hernia. Objective evaluation at 5 years identified an additional 3 recurrences, for a total recurrence rate of 25% (8 of 32 patients). The hernia recurrence rate in patients with a Collis gastroplasty was significantly lower than in those without a Collis (7% vs 54%, p = 0.008). Two patients underwent reoperation for hernia recurrence. No patient had a mesh infection or mesh erosion. CONCLUSIONS: The combination of Phasix ST Mesh and tension-reducing techniques during PEH repair led to a 25% hernia recurrence rate at 5 years. The addition of a Collis gastroplasty led to significantly fewer hernia recurrences and is indicative of the potential for esophageal shortening in many patients with a PEH. The long-term safety and efficacy of Phasix ST Mesh in combination with surgical technique for PEH repair is confirmed.
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Hernia Hiatal , Herniorrafia , Laparoscopía , Recurrencia , Mallas Quirúrgicas , Humanos , Hernia Hiatal/cirugía , Estudios Prospectivos , Herniorrafia/métodos , Herniorrafia/instrumentación , Herniorrafia/efectos adversos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Resultado del Tratamiento , Laparoscopía/métodos , Estudios de Seguimiento , Implantes Absorbibles , Gastroplastia/métodos , Gastroplastia/efectos adversos , Gastroplastia/instrumentación , Adulto , Anciano de 80 o más AñosRESUMEN
BACKGROUND: Obesity is a significant health problem in South Africa. Surgery is the most effective means of durable weight loss for the morbidly obese. Of the surgical options, laparoscopic adjustable gastric banding is the most controversial. We aimed to assess a single surgeon's experience with a specific band. METHODS: A retrospective observational study of a continuous cohort of laparoscopic adjustable gastric Cousin Bioring® band placements from a single private South African hospital was conducted. Three hundred and fifty bands were placed in 347 patients, 75% were female. Variables analysed were BMI obesity class, comorbidities, weight loss, diabetes resolution, adherence to aftercare, patient satisfaction, complications and death. RESULTS: Outcomes were assessed in 343 patients (4 patients lost to follow-up). The mean follow-up was 39 months (IQR 29-66 months). The mean preoperative BMI was 43.3 kg/m2 (IQR 37.4-47.6 kg/m2). Most weight loss occurred in the first year, and 66% achieved > 40% excess weight loss. Resolution of type 2 diabetes and prediabetes occurred in 56.4% and 89.8% of patients respectively. Increasing age (p = 0.002), class 3 obesity (p < 0.001) and suboptimal aftercare (p < 0.001) were associated with failure. One patient developed band erosion and 40 developed band slippage, 34 of whom underwent secondary surgery (32 removals, 2 revisions). All complications were grade I-III. There was no high grade complication, and no death. CONCLUSIONS: Bioring® gastric banding achieved moderately good weight loss and resolution of type 2 diabetes with a low complication rate. BMI > 60 and suboptimal aftercare predicted poor outcome.
Asunto(s)
Gastroplastia/instrumentación , Laparoscopía , Obesidad Mórbida/cirugía , Adulto , Índice de Masa Corporal , Femenino , Hospitales Privados , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sudáfrica , Resultado del Tratamiento , Pérdida de PesoRESUMEN
BACKGROUND: Laparoscopic adjustable gastric band complications like oesophageal dilatation, intractable nausea and vomiting, band migration, late slippages, and port problems with a cumulative rate of 19.2%. Rarely, LAGB complications may be related to the connection tube system and in this case the clinical presentation and the effects of the problem can generate difficulties in diagnosis. METHODS: A 47 years old woman who had a LAGB placed 2 years before the symptoms was admitted in our centre with nausea, vomit, leukocytosis and distended abdomen with a generalized tenderness. Computed tomography images showed an anomalous course of banding tube and a contemporary compression of a small bowel tract secondary to the traction exerted by an adipose tissue band attracted by the tube. RESULTS: A laparoscopic exploration of the abdominal cavity showed a tight loop of LAGB tubing causing a small bowel obstruction with an ischemic damage, so surgeons provided to LAGB removal and a 50 cm ileum resection CONCLUSIONS: Small bowel obstruction resulting from LAGB tubing is an uncommon complication which was reported in few cases. Although bariatric surgery currently represents the best treatment option for morbid obesity and its related- diseases, peri- and post-operative complications have always to be taken into account. KEY WORDS: Adjustable gastric band complications, Bariatric surgery, Bowel obstruction, CT scan, LAGB tube.
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Gastroplastia , Obstrucción Intestinal , Laparoscopía/efectos adversos , Tejido Adiposo , Femenino , Gastroplastia/efectos adversos , Gastroplastia/instrumentación , Humanos , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Intestino Delgado , Persona de Mediana Edad , Obesidad/cirugíaRESUMEN
El verdadero esófago corto es una entidad que causa mucha controversia entre los cirujanos. Se han publicado estudios acerca de su diagnóstico y tratamiento laparoscópico, sin que a día de hoy existan publicaciones del tratamiento con abordaje robótico. Presentamos, en forma de caso clínico, nuestra experiencia en cirugía robótica de hernia de hiato con verdadero esófago corto tratada con gastroplastia de Collis y fundoplicatura de Toupet. La cirugía robótica en el verdadero esófago corto puede facilitar la disección mediastínica y permitir una técnica de sutura más precisa. Son necesarios estudios para comparar los resultados a largo plazo de esta técnica quirúrgica entre el abordaje laparoscópico convencional y el abordaje robótico
The true short esophagus is an entity of controversy among surgeons. Studies have been published about its diagnosis and laparoscopic treatment, without existing to date, publication of the treatment with robotic approach. We present, as a case report, our experience in robotic surgery for hiatal hernia with true short esophagus treated with Collis gastroplasty and Toupet fundoplication. Robotic surgery on the true short esophagus can facilitate mediastinal dissection and allow a more accurate suture technique. Studies are needed to compare the long-term results of this surgical technique between the conventional laparoscopic approach and the robotic approach
Asunto(s)
Humanos , Femenino , Anciano , Enfermedades del Esófago/cirugía , Gastroplastia/instrumentación , Procedimientos Quirúrgicos Robotizados/métodos , Enfermedades del Esófago/diagnóstico , Fundoplicación/métodos , Reflujo Gastroesofágico/diagnóstico , Reflujo Gastroesofágico/etiología , Hernia Hiatal/diagnóstico por imagen , Hernia Hiatal/cirugía , Laparoscopía/métodos , Tomografía Computarizada por Rayos X/métodosAsunto(s)
Tratamiento de Urgencia/métodos , Hernia Hiatal/cirugía , Vólvulo Gástrico/cirugía , Descompresión Quirúrgica/instrumentación , Descompresión Quirúrgica/métodos , Tratamiento de Urgencia/instrumentación , Fundoplicación/instrumentación , Fundoplicación/métodos , Gastroplastia/instrumentación , Gastroplastia/métodos , Hernia Hiatal/complicaciones , Hernia Hiatal/diagnóstico , Humanos , Laparoscopía/instrumentación , Laparoscopía/métodos , Prevención Secundaria/instrumentación , Prevención Secundaria/métodos , Vólvulo Gástrico/diagnóstico , Vólvulo Gástrico/etiología , Tomografía Computarizada por Rayos X , Técnicas de Cierre de HeridasRESUMEN
BACKGROUND: After laparoscopic Roux-en-Y gastric bypass (RYGB), approximately 10-35% of patients with morbid obesity regain weight after an initial good result or fail to achieve a sufficient amount of weight loss. Patients in which conservative measures are not successful may potentially benefit from revisional surgery. OBJECTIVE: To evaluate the effect of a non-adjustable ring placed around the gastric pouch in patients with insufficient weight loss or weight regain after RYGB. SETTING: Four specialized bariatric hospitals in The Netherlands, Germany, and Switzerland. METHODS: From 2011 to 2017, 79 patients underwent revisional surgery using a non-adjustable silicone ring because of insufficient results after RYGB. Data on weight loss and complications up to 2 years after revisional surgery was collected and analyzed retrospectively. RESULTS: A follow-up percentage of 86% after 1 year and 61% after 2 years was achieved. In 75% of patients, further weight regain was prevented. Percentage total body weight loss improved by 7 to 26% 1 year after revisional surgery and remained stable during 2 years of follow-up. The additional weight loss effect of placing a non-adjustable ring was more pronounced in patients with an initial good result after primary RYGB. Eighteen (23%) rings were removed, most often due to dysphagia. CONCLUSION: Especially for patients who experience weight regain after initial good weight loss, placing a non-adjustable silicone ring around the gastric pouch results in modest improvements in weight loss. To prevent the risk of ring removal due to dysphagia, surgeons should take notice not to place the ring too tight around the gastric pouch during revisional surgery.
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Equipos y Suministros , Derivación Gástrica/efectos adversos , Gastroplastia , Obesidad Mórbida/cirugía , Reoperación , Adulto , Estudios de Cohortes , Equipos y Suministros/efectos adversos , Femenino , Derivación Gástrica/métodos , Gastroplastia/efectos adversos , Gastroplastia/instrumentación , Gastroplastia/métodos , Alemania/epidemiología , Humanos , Laparoscopía/efectos adversos , Laparoscopía/instrumentación , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Obesidad Mórbida/diagnóstico , Obesidad Mórbida/epidemiología , Reoperación/efectos adversos , Reoperación/instrumentación , Reoperación/métodos , Estudios Retrospectivos , Siliconas/química , Estómago/cirugía , Suiza/epidemiología , Resultado del Tratamiento , Pérdida de Peso/fisiologíaRESUMEN
The true short esophagus is an entity of controversy among surgeons. Studies have been published about its diagnosis and laparoscopic treatment, without existing to date, publication of the treatment with robotic approach. We present, as a case report, our experience in robotic surgery for hiatal hernia with true short esophagus treated with Collis gastroplasty and Toupet fundoplication. Robotic surgery on the true short esophagus can facilitate mediastinal dissection and allow a more accurate suture technique. Studies are needed to compare the long-term results of this surgical technique between the conventional laparoscopic approach and the robotic approach.
Asunto(s)
Enfermedades del Esófago/cirugía , Gastroplastia/instrumentación , Procedimientos Quirúrgicos Robotizados/métodos , Anciano , Enfermedades del Esófago/diagnóstico , Femenino , Fundoplicación/métodos , Reflujo Gastroesofágico/diagnóstico , Reflujo Gastroesofágico/etiología , Hernia Hiatal/diagnóstico por imagen , Hernia Hiatal/cirugía , Humanos , Laparoscopía/métodos , Tomografía Computarizada por Rayos X/métodosRESUMEN
Technological advances have permitted minimally invasive treatment of many gastrointestinal diseases. With the advent of endoscopic full-thickness suturing, it has become possible to replicate some of the surgical procedures. Endoluminal bariatric procedures to remodel and reduce the gastric volume similar to surgery is evolving as a treatment option for obesity. Some of these methods also have been extended to treat weight regain after gastric bypass surgery. There is a steep learning curve to gaining proficiency with different endoscopic gastric remodeling or gastroplasty techniques. This article describes a simplified technique of endoscopic sleeve gastroplasty using the OverStitch suturing device.
Asunto(s)
Endoscopía/instrumentación , Gastroplastia/instrumentación , Obesidad/cirugía , Estómago/cirugía , Técnicas de Sutura/instrumentación , Endoscopía/métodos , Europa (Continente) , Gastroplastia/métodos , Humanos , Resultado del TratamientoRESUMEN
OBJECTIVE: Laparoscopic adjustable gastric banding (LAGB) is rapidly becoming a deprecated bariatric procedure due to disappointing weight loss results and a high rate of band intolerance. Conversion to Roux-en-Y gastric bypass is a common revisional procedure after failed LAGB. The aim of this study was to evaluate the feasibility, safety, and risk profile of conversion to adjustable banded Roux-en-Y gastric bypass (ABRYGB). METHODS: A retrospective patient file review of all consecutive laparoscopic conversions of LAGB to ABRYGB 2008-2017. Pre/perioperative data, weight change, and long-/short-term complications were retrieved. RESULTS: Study population 98 patients. Mean BMI before revision was 40,15 kg/m2. Most revisional procedures were performed for band intolerance and/or weight regain or weight loss failure. All procedures were performed laparoscopically. During follow-up, 16 bands had to be removed due to one of the following reasons: infection, anastomotic leakage, anastomotic peptic perforation, adhesions around the anastomosis, internal hernia around the tubing, adhesions to the tubing, tubing failure, and erosion of the band. Three of those bands were replaced with a non-adjustable Silastic (Minimizer) ring. In total, issues with tubing requiring an intervention were found in 20 patients after conversion to ABRYGB. Seven revisional procedures had to be performed for symptomatic internal hernias not related to the tubing and incidental internal hernias were found in another 7 procedures. CONCLUSION: Although conversion of LAGB to ABRYGB is technically feasible, initially well-tolerated, and has good weight loss results, the number of additional procedures during follow-up is rather high, suggesting that leaving the band in place should not be advised.
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Derivación Gástrica/métodos , Gastroplastia/instrumentación , Obesidad Mórbida/cirugía , Reoperación/métodos , Adolescente , Adulto , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Derivación Gástrica/instrumentación , Gastroplastia/métodos , Humanos , Laparoscopía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Reoperación/instrumentación , Estudios Retrospectivos , Resultado del Tratamiento , Pérdida de Peso , Adulto JovenAsunto(s)
Cirugía Bariátrica/efectos adversos , Cuidados Posoperatorios/métodos , Fuga Anastomótica/cirugía , Urgencias Médicas , Cálculos Biliares/etiología , Cálculos Biliares/cirugía , Derivación Gástrica/efectos adversos , Gastroplastia/efectos adversos , Gastroplastia/instrumentación , Gastroplastia/métodos , Humanos , Grapado Quirúrgico/efectos adversosAsunto(s)
Coagulación con Plasma de Argón/métodos , Remoción de Dispositivos/métodos , Endoscopía/métodos , Gastrectomía/efectos adversos , Gastroplastia/efectos adversos , Gastroplastia/instrumentación , Adulto , Femenino , Gastrectomía/instrumentación , Humanos , Obesidad Mórbida/cirugía , SiliconasRESUMEN
INTRODUCTION: Obesity is a pandemic associated with significant comorbidities such as type 2 diabetes (T2DM). RYGB is an effective treatment modality for obesity and T2DM. However, bariatric surgery is currently limited to a relatively small population of patients. The duodenal-jejunal bypass sleeve (DJBS) has recently emerged as a promising therapy for obesity and T2DM by providing similar physiological effects to RYGB. We describe a case of a patient with a previously placed DJBS presenting with abdominal pain from anchor erosion managed with an endoscopic approach. METHODS: A 58-year-old man with obesity and T2DM who had failed prior medical therapy for obesity was referred for DJBS placement. This was placed without complications. At 8 weeks follow-up, he developed abdominal pain and vomiting prompting immediate endoscopic evaluation. RESULTS: EGD revealed an anchor erosion resulting in mild stenosis of the pylorus. Additionally, hyperplastic tissue was found to be adhered to the device in the duodenal bulb. Endoscopic removal with balloon dilation was unsuccessful, and a stent was placed in a "stent-in-stent" fashion through the sleeve to compress the area of tissue ingrowth encouraging local tissue necrosis and device extraction. At 15 days follow-up, the stent was removed; however, the DJBS remained adhered and immobile. Next, the ingrowing hyperplastic tissue was resected in a piecemeal fashion. This resulted in mobilization of the sleeve anchors in the duodenal bulb and successful removal of the DJBS. CONCLUSIONS: DJBS endoscopic removal is safe and effective even in challenging cases, thus preventing the need for surgical intervention.
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Diabetes Mellitus Tipo 2/cirugía , Endoscopía Gastrointestinal/métodos , Falla de Equipo , Gastroplastia/efectos adversos , Obesidad/cirugía , Píloro/cirugía , Remoción de Dispositivos/métodos , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/patología , Duodeno/patología , Duodeno/cirugía , Gastroplastia/instrumentación , Humanos , Yeyuno/patología , Yeyuno/cirugía , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Obesidad/patología , Píloro/patología , Resultado del TratamientoRESUMEN
BACKGROUND AND AIM: A wide variety of foreign bodies have been found in the urinary bladder, most often due to self-introduction and autoerotism, or iatrogenically introduced during surgery in the anatomic region. We report the first case of a gastric banding clip found in the urinary bladder. CASE PRESENTATION: We describe the case of a 33-year-old Chinese female who had previously undergone gastric banding and subsequent removal of the band. She presented with lower urinary tract symptoms which followed a diurnal pattern, and investigations revealed a portion of a gastric banding clip in the urinary bladder. There was no sign of perforation or erosion of the bladder. The clip was surgically removed and the patient recovered without complications. DISCUSSION AND CONCLUSION: This is the first reported case of an intraperitoneal gastric banding clip migrating extraperitoneally into the urinary bladder. The use of the urinary bladder to expel foreign bodies has been documented in other vertebrates, and the mechanism by which this occurs without perforation or erosion of the urinary bladder warrants further investigation.
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Migración de Cuerpo Extraño/etiología , Gastroplastia/instrumentación , Vejiga Urinaria , Adulto , Femenino , Humanos , Instrumentos Quirúrgicos/efectos adversosRESUMEN
OBJECTIVE: This study was undertaken to examine the factors contributing to laparoscopic adjustable gastric band (LAGB) removals among adults > 18 years of age. We hypothesized that female patients with multiple comorbidities would have increased removals. DESIGN: This retrospective exploratory study uses internal records and standard statistical methods of analysis. RESULTS: Eighty-five bands were removed (11.8% males, 88.2% females). The average BMI was 40.7 (n = 83). 2.4% of patients had removals between 0 and 12 months, 18.8% between 39 and 51 months, and 35.3% between 39 and 64 months. 8.2% of treatment times were unknown. The average treatment time was 67.9 months. 48.2% of patients had ≥ 2 comorbidities, GERD (44.2%) being the most frequent. 49.4% of patients reported dysphagia as the reason for band removal. 22.4% of removals were associated with band failures, none with port complications. The reason for band removal was unknown in 21.2% of patients. 67.1%, 32.9%, and 23.5% attended 30-, 60-, and 90-day follow-up appointments, respectively. Weight post-band removal surgery at 30, 60, and 90 days was noted to be - 0.4%., 0.9%, and 0.4%, respectively. CONCLUSION: This study supports current literature suggesting LAGB may not be an effective long-term surgical intervention for obesity. Patients with > 2 comorbidities had increased rates of removal. Dysphagia was noted to be the primary reason cited for LAGB removal. Postoperative follow-up was found to be a significant challenge for LAGB removal patients. Further study is warranted to explore if these poor follow-up rates should be considered when risk stratifying LAGB patients for revisional surgery.
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Remoción de Dispositivos , Gastroplastia , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias/epidemiología , Adolescente , Adulto , Cirugía Bariátrica/efectos adversos , Cirugía Bariátrica/instrumentación , Cirugía Bariátrica/rehabilitación , Cirugía Bariátrica/estadística & datos numéricos , Comorbilidad , Trastornos de Deglución/epidemiología , Trastornos de Deglución/etiología , Trastornos de Deglución/cirugía , Remoción de Dispositivos/efectos adversos , Remoción de Dispositivos/rehabilitación , Remoción de Dispositivos/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Gastroplastia/efectos adversos , Gastroplastia/instrumentación , Gastroplastia/rehabilitación , Gastroplastia/estadística & datos numéricos , Humanos , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Obesidad Mórbida/epidemiología , Complicaciones Posoperatorias/etiología , Reoperación/efectos adversos , Reoperación/métodos , Reoperación/rehabilitación , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND AND AIM: Severe obesity is a public health care system challenge that requires bariatric surgery. Among the plethora of bariatric surgery techniques silastic ring vertical gastroplasty (SRVG) is a safe and efficient restrictive method that has been successfully used previously. However, it's performance by open approach has been abandoned and replaced by other methods using the laparoscopic method. The aim of the present study was to investigate patients with severe obesity submitted to open SRVG and to report our results over a period of 10 years in terms of weight loss, late complications and surgical re-interventions. MATERIAL AND METHODS: 112 severely obese patients submitted to open SRVG between years 2008- 2009 were investigated retrospectively for body mass index (BMI), percent excess BMI loss (%EBMIL), late surgical complications and reoperations. 41.96% of the patients were followed up 10 years after SRVG. Results: The initial mean BMI was 47.38 +- 7.59 kg/m2 and dropped statistically significant (p 0.001) to 31.05 +- 6.54 kg/m2 by the first year after SRVG. The mean BMI was rather stable along the first 5 years after SRVG when it started to increase gradually, reaching 35.93 +- 7.20 kg/m2 by the 10th year of follow-up when it remained still significantly lower (p 0.001) as compared to the mean baseline value. The %EBMIL was 79% at one year after surgery and reached 51% by the 10th year of follow-up. The most frequent late complications after SRVG were stoma stenosis (8.92%), enlargement of the stoma (8.03%) and incisional hernia (3.36%). As a consequence of stoma stenosis the ring has been removed in all cases. In 2 cases, after the ring removal, the patients underwent gastric bypass. CONCLUSION: SRVG is a safe and efficient restrictive technique of bariatric surgery open to many options to be revised, leading to a successful sustained long term weight loss and maintenance. Stoma stenosis, enlargement of the stoma and incisional hernia are the most frequent late complications after SRVG requesting reoperations.