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INTRODUCTION AND IMPORTANCE: By 2030 it is predicted that 1 in 5 women and 1 in 7 men will be living with obesity. The only long-term effective strategy for achieving significant weight loss over time is surgical treatment. One Anastomosis Gastric Bypass (OAGB) has been proposed as an effective therapeutic option. Stenosis of Gastro-Jejunal Anastomosis (GJA) is one of the most common long-term complications and its cause recognized as multifactorial. CASE PRESENTATION: We present the case of a patient with a history of progressive postoperative oral intolerance after OAGB with 60 kg weight loss (BMI 20.7 kg/m2). Severe stenosis of the GJA and massive dilation of the gastric remnant was documented, treated multiple times with endoscopic balloon dilation. He was referred to our unit due to persistent symptoms. Revision surgery to a Gastric Bypass was programmed, ultimately performed via an open approach with resection of 80 % of the gastric remnant. CLINICAL DISCUSSION: Endoscopic dilatation and surgical revision are the two primary treatment options for GJA stricture. In refractory cases to pneumatic dilation, laparoscopic revision surgery is indicated, however an open approach is frequently required, as surgeries are technically demanding due to distorted anatomy in this population. CONCLUSION: Operations to correct chronic complications are tailored to the patient's anatomy as well as the symptoms or pathologies they are intended to correct. Whilst revision surgeries are associated with an increased risk of conversion, complications and longer hospital stay, they can be performed safely in experienced centers.
RESUMO
A homogeneous fluorescence-polarization assay (FPA) was used for the serological diagnosis of bovine brucellosis in México. The assay uses O-polysaccharide prepared from Brucella abortus lipoplysaccharide (20-30 kDa) conjugated with fluorescein isothiocyanate as a tracer. To measure the fluorescence polarization, a FPM-1 fluorescence-polarization analyzer was used with the procedure described by Nielsen et al. (1996b). A cut-off value of 90 millipolarization (mP) units was used for testing 560 bovine sera from different areas of México. (305 positive sera and 255 negative sera according to the complement fixation test; CFT.) Some were tested with the Rose Bengal plate (RB) test (n = 490) and some with the rivanol-agglutination (RIV) test (n = 190). Sensitivities were 98.3%, 99.3% and 99.0%, and specificities were 68.8%, 55.4% and 96.9%, respectively, for RB, RIV and FPA. The FPA gave a kappa coefficient of agreement with respect to CFT of 0.96, while RB and RIV (relative to the CFT) gave coefficients of 0.70 and 0.61, respectively. Finally, ROC analysis suggested a cut-off value which agreed with the one recommended in the test procedure. We concluded that FPA is a suitable test to be used instead of the CFT in Mexican conditions.