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1.
Iliana Gonzalez-Pezzat Enrique Soto-Perez-de-Celis Juan Pablo Pantoja-Millan 《Obesity surgery》2009,19(5):661-663
Late complications involving the site of the jejunojejunal (J-J) anastomosis are uncommon after laparoscopic Roux-en-Y gastric
bypass. We present a case of a perforation at the J-J anastomosis complicated by the formation of an abscess 6 months after
surgery. Following clinical and radiological evaluation, the patient underwent an exploratory laparoscopy which had to be
converted to an open technique because of technical difficulties. The abscess was drained, the anastomosis was resected, and
a new anastomosis was undertaken. When the surgical specimen was inspected, a perforation was found at the site of the previous
J-J anastomosis. The patient had an uneventful recovery. To our knowledge, this is the first report of the formation of an
abscess due to a perforation at the site of the J-J anastomosis after laparoscopic Roux-en-Y gastric bypass surgery. This
complication, although rare, should be taken into account in patients with abdominal pain and systemic inflammatory response
syndrome after bariatric surgery.
No commercial interests to disclose. 相似文献
2.
Ramya Kalaiselvan Mahmoud Abu Dakka Basil J. Ammori 《Surgery for obesity and related diseases》2013,9(6):874-878
BackgroundAlthough marginal ulceration and perforation at the gastrojejunal anastomosis is an established, albeit rare, risk after laparoscopic Roux-en-Y gastric bypass (LRYGB) for morbid obesity, little is known about the risk of late perforation at the jejuno-jejunal (J-J) anastomosis. The objective of this study was to identify the incidence of J-J perforation and describe management options and sequelae.MethodsThis is a retrospective review of the database of all patients who underwent LRYGB. The results are presented as mean (range) where appropriate.ResultsBetween April 2002 and April 2012, 1652 patients underwent LRYGB (1577 primary and 75 revision procedures). The operative mortality was .18%. Three patients developed late perforation of the J-J anastomosis (.18%) at 7, 9, and 18 weeks, respectively. Two patients were managed with resection and reanastomosis of the perforation by laparotomy, and a third patient was managed laparoscopically with peritoneal lavage and transcutaneous tube jejunostomy of the perforation. All patients recovered well postoperatively. However, the third patient represented 42 days later with sepsis and died secondary to recurrent J-J ulcer perforation.ConclusionPerforation of the J-J anastomosis is a rare and life-threatening delayed complication after LRYGB and usually presents within 2–8 months postoperatively. It poses difficulties with diagnosis and management and should be dealt with judiciously. 相似文献
3.
Introduction: Small bowel obstruction (SBO) is a well-known complication of laparoscopic Roux-en-Y gastric bypass (LRYGBP).
We describe 7 cases of jejunojejunal anastomotic obstruction related to adhesion formation after closure of the mesenteric
"leaves" defect with non-absorbable suture. Methods: All patients undergoing LRYGBP from October 2002 until February 2005
were entered into a prospective, longitudinal database. All patients who subsequently presented with SBO were analyzed. Results:
Jejunojejunal anastomotic obstruction occurred in 7 out of 152 patients (4.6%) in whom LRYGBP was performed from October 2002
to February 2004. Since February 2004, the suture used to close the jejunojejunal mesenteric leaves defect was changed from
non-absorbable Dacron (Surgidac™) to absorbable suture material. The mean interval between initial LRYGBP and subsequent SBO was 153 days. Operative findings
common to all 7 cases were dilated loops of proximal small bowel, and a single adhesion just distal to the Roux-Y anastomosis.
Following adhesiolysis, each patient had prompt return of bowel function without recurrence of obstruction. Of the 156 patients
who have since undergone LRYGBP, none have presented with SBO, and this difference is statistically significant (P=0.008). Conclusions: The overall rate of SBO (2.3%) is consistent with the previous literature, although the incidence of
adhesions specifically at the jejunojejunal anastomosis is higher than that previously encountered. It appears that the incidence
of postoperative SBO at the jejunojejunal anastomosis is directly linked to the choice of suture material intraoperatively.
As such, absorbable suture should be used to close the jejunojejunal mesenteric leaves defect. 相似文献
4.
《Surgery for obesity and related diseases》2014,10(4):666-670
BackgroundJejuno-jejunal (J-J) intussusception is a rare complication after Roux-en-Y gastric bypass (RYGB). Prompt diagnosis is critical as it may lead to obstruction and bowel necrosis, but clinical presentation is nonspecific. A definitive treatment plan has not been established with intussusception after RYGB. The aim of our study was to describe clinical presentation and outcomes of treatment in patients with intussusception after RYGB.MethodsOut of 3022 patients who underwent laparoscopic RYGB between January 2003 and January 2013, 12 (0.4%) patients presented with intussusception after RYGB. A retrospective review of a prospectively collected database was performed.ResultsOf the 12 patients, 11 (91.7%) presented with left or right upper quadrant abdominal pain as their chief complaint, and 1 (8.3%) presented with persistent nausea and vomiting. Diagnosis was made by computed tomographic scan (n = 1) or intraoperative findings (n = 11) at a mean period of 24.9±26.0 months (range 3–85) after laparoscopic RYGB. Seven (58.3%) patients were treated only with reduction, 2 (16.7%) with resection and revision of J-J anastomosis, the remaining 3 (25.0%) underwent imbrication/plication of the J-J anastomosis. Only 1 (8.3%) patient, who was treated by reduction, returned with subsequent finding of recurrent intussusception at 9 months. All patients did well at a mean follow-up of 12.7±16.4 months (range 1–47).ConclusionWhile reduction alone of the intussusception is safe and effective, there is a risk of recurrence, and imbrication of the J-J anastomosis may be a more effective means of treatment. 相似文献
5.
Background Roux-en-Y gastric bypass (RYGBP) has been demonstrated to be an effective treatment for weight loss in the morbidly obese.
Numerous variations of the RYGBP have been performed, including placing a ring proximal to the gastric outlet. This ring in
RYGBP is intended to decrease pouch dilation and limit weight regain. We reviewed our experience in laparoscopic re-operation
after open banded RYGBP.
Methods All charts of patients who underwent laparoscopic revisional bariatric surgery were reviewed. Patients who had laparoscopic
removal of the band following the open banded RYGBP were reviewed in this study.
Results There were 4 patients who had laparoscopic removal of the band. The indication in all patients was dysphagia and emesis. The
ring removed was a silicone band (1) and a large braided non-absorbable suture (3). After the laparoscopic reoperation, there
was immediate relief. There has been an average of 5.8 kg weight regain at average followup of 30 months.
Conclusions This complication after open banded RYGBP may require operative intervention. Laparoscopic removal of a band is feasible and
safe. 相似文献
6.
Background: We evaluated the safety and feasibility of performing a laparoscopic intracorporeal end-toside small bowel anastomosis
using a stapling technique as part of a Roux-en-Y gastric bypass operation (RYGBP). Methods: 80 consecutive patients who underwent
RYGBP with laparoscopic jejunojejunostomy were evaluated. Operative time and intraoperative and postoperative complications
directly related to the jejunojejunostomy anastomosis were recorded. Results: All 80 laparoscopic jejunojejunostomy procedures
were successfully performed without conversion to laparotomy. Mean operative time was longer for the first 40 laparoscopic
RYGBP than for the last 40 RYGBP (32±18 min vs 21±14 min, respectively, p<0.05). Intraoperative complications were staple-line
bleeding (2 patients) and narrowing of the anastomosis (1 patient). Postoperative complications were four small bowel obstructions:
technical narrowing at jejunojejunostomy site (2 patients), angulation of the afferent limb (1 patient), and food impaction
at the jejunojejunostomy anastomosis (1 patient). These four patients underwent successful laparoscopic re-exploration and
creation of another jejunojejunostomy proximal to the original anastomosis. There were no small bowel anastomotic leaks. The
median time to resuming oral diet was 2 days. Conclusions: Laparoscopic jejunojejunostomy as part of the RYGBP operation is
a safe and technically feasible procedure. Postoperative small bowel obstruction is a potential complication, which can be
prevented by avoiding technical narrowing of the afferent limb. 相似文献
7.
Ramsey M. Dallal M.D. F.A.C.S. Linda A. Bailey P.A.C. 《Surgery for obesity and related diseases》2006,2(4):11-459
BACKGROUND: The mechanism of marginal ulceration after laparoscopic gastric bypass surgery is poorly understood. We reviewed the incidence, presentation, and outcome of ulcer disease in consecutive patients undergoing laparoscopic gastric bypass surgery. METHODS: The outcomes of 201 consecutive laparoscopic gastric bypass surgery procedures were prospectively analyzed for complications. All procedures were performed using a linear stapled anastomosis and absorbable suture. RESULTS: The incidence of marginal ulcer disease was 3.5% (7 patients). One patient, the only smoker, presented with an acute perforation 4 months postoperatively. Three other patients presented with bleeding-all required transfusion. The remaining 3 patients presented with severe pain. At endoscopy, all patients had ulcerations associated with the Roux limb mucosa and were all successfully treated using proton pump inhibitors and sucralfate therapy. Symptoms of marginal ulceration occurred an average of 7.4 months (range 3-14) after surgery. The average follow-up was 19.8 months. No preoperative factors were predictors of ulcer disease, including body mass index, age, gender, or co-morbidities. CONCLUSION: Marginal ulcers using the linear-stapled technique occurred in 3.5% of patients. Three distinct clinical presentations occurred: bleeding, pain, or perforation. No preoperative risk factors were identified that predicted for this complication. Medical management is an effective treatment. 相似文献
8.
腹腔镜消化性溃疡穿孔修补术23例 总被引:4,自引:3,他引:4
目的探讨腹腔镜消化性溃疡穿孔修补术的方法和治疗效果. 方法应用腹腔镜对23例消化性溃疡穿孔(十二指肠穿孔17例,胃窦部前壁穿孔5例,胃体部小弯侧穿孔1例)行穿孔修补﹑腹腔引流术. 结果手术均获成功,无手术并发症.3个月后胃镜复查,13例使用丝线者均有缝线外露,10例使用可吸收外科缝线者无缝线外露.随访6~27个月,平均18个月,3例十二指肠球部穿孔者仍有轻度嗳气,返酸,余无明显症状,无再穿孔. 结论腹腔镜消化性溃疡穿孔修补术安全可靠,术后继续正规内科治疗,效果满意. 相似文献
9.
10.
Endoscopy is commonly used in patients undergoing Roux-en-Y gastric bypass (RYGBP) for diagnosis and intervention. Stomal
stricture at the gastrojejunostomy occurs in approximately 3% to 17% of patients after laparoscopic RYGBP. The incidence of
iatrogenic perforation during stomal balloon dilatation is reported to be 3% to 12% among these patients. Surgery has typically
been required for iatrogenic perforation. With the availability of the endoclip, endoscopists are able to manage iatrogenic
perforation non-operatively. We report a patient who had jejunal perforation during balloon dilatation after RYBGP, who was
successfully closed with endoclip applications and managed non-operatively. 相似文献
11.
Background: Laparoscopic Roux-en-Y gastric bypass (RYGBP) has been shown to be a safe and effective alternative to traditional
"open" RYGBP. Although lack of postoperative adhesions is one advantage of minimally invasive surgery, this is also responsible
for a higher incidence of internal hernias. These patients often present with intermittent abdominal pain or small bowel obstruction
with completely normal contrast radiographs. Methods: Data was obtained concurrently on 2,000 consecutive patients from February
1998 to October 2001 and analyzed retrospectively. Radiographs, when available, were interpreted by both the operative surgeon
and radiologist before intervention. Results: 66 internal hernias occurred in 63 patients, an incidence of 3.1%. 1 patient
presented with a traditional adhesive band and small bowel obstruction. 20% of patients had normal preoperative small bowel
series and/or CT scans. The site of internal hernias varied: 44 - mesocolon; 14 - jejunal mesentery; 5 - Petersen's space.
Although most patients were symptomatic, 5% were incidental findings at the time of another surgical procedure. 5 patients
required open repair. 6 patients presented with perforation either at the time of diagnosis or as a result of manipulation
of the bowel. There was 1 death associated with complications of the internal hernia. The negative exploration rate was 2%.
Conclusion: Internal hernias are more common following laparoscopic RYGBP than "open" RYGBP. Contrast radiographs alone are
unreliable in ruling out this diagnosis. Early intervention is crucial; most repairs can be performed laparoscopically. This
diagnosis should be entertained in all patients with unexplained abdominal pain following laparoscopic RYGBP. Meticulous closure
of all potential internal hernia sites is essential to limit this potentially lethal complication. 相似文献
12.
Steven J Binenbaum Roy M Dressner Frank J Borao 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2007,11(3):383-388
OBJECTIVES: We present 2 patients with free perforation of the anterior wall of the Roux limb due to marginal ulceration after an antecolic laparoscopic gastric bypass and describe the surgical management and laparoscopic repair technique. METHODS: A 15 mm Hg pneumoperitoneum was established with a Veress needle via the left subcostal approach in both patients. Entrance into the abdomen was achieved with the 5 mm Optiview blunt trocar. The Genzyme liver retractor was used to lift the left lobe of the liver and expose the gastrojejunal anastomosis. A 30 degrees 5 mm telescope was used for visualization. In both cases, free fluid and purulent material were noted in the subdiaphragmatic region and along the right paracolic gutter, but the gastrojejunal anastomoses was intact. A 1 cm perforation with surrounding inflammatory exudate was identified on the anterior surface of the Roux limb distal to the gastrojejunostomy. The edges were debrided and intracorporeal 1-layer repair of the ulcer was performed with simple interrupted 2-0 Vicryl sutures. Fibrin glue was applied to the suture line and covered with an omental onlay patch. The anastomosis was tested with air insufflation and methylene blue dye with no evidence of a leak. A Jackson-Pratt drain was placed in the left upper quadrant. RESULTS: Both patients underwent an unremarkable hospital course, and follow-up EGD examination after 3 months revealed no evidence of ulceration. CONCLUSION: Laparoscopic exploration and the repair of the gastrointestinal perforations in patients with a recent history of laparoscopic RYGBP is safe, if patients are hemodynamically stable and present within the first 24 hours of the onset of symptoms. 相似文献
13.
目的 探讨单向可吸收倒刺线与PDS-II缝线在腹腔镜胰十二脂肠切除术胆肠吻合中的应用价值。方法采用回顾性队列研究方法,收集2017年1月至2020年6月内江市第二人民医院收治的60例行腹腔镜胰十二脂肠切除术患者的临床资料,其中30例患者胆肠吻合时采用单向可吸收倒刺线,设为倒刺线组;另30例患者胆肠吻合时采用PDS-II缝线,设为PDS-II组。观察两组手术时间、术中出血量、肝总管直径、胆肠吻合口内径和术后并发症情况。结果 (1)术中情况:两组患者均完成腹腔镜根治性胰十二指肠切除术,胆肠吻合均采用横结肠后Roux-en-Y吻合方式,均未放置T管引流,无姑息性胆肠吻合减黄。与PDS-II组比较,倒刺线组胆肠吻合手术时间缩短[(13.2±8.1)min vs(15.8±7.6)min],差异有统计学意义(P<0.05),但术中出血量[(80±8)mL vs(94±5)mL]、肝总管直径[(1.5±0.6)cm vs(1.3±0.8)cm]、胆肠吻合口内径[(1.3±0.8)cm vs(1.1±0.6)cm],两组差异均无统计学意义(P>0.05)。(2)术后情况:与PDS-II组比较,倒刺线组患者术后胆漏[0例(0)vs 3例(10%)]、术后胆肠吻合口后方引流管拔出时间[(3.8±0.9)d vs(7.2±0.3)d]、术后住院时间[(7.8±0.9)d vs(10.2±0.6)d]均降低,差异有统计学意义(P<0.05)。(3)随访情况:60例患者均获得随访,随访时间6~12个月,中位随访时间8个月,与PDS-II组比较,倒刺线组患者术后胆肠吻合口狭窄[2例(6.7%)vs 5例(16.7%)]和狭窄胆肠吻合口拆除再吻合发生率下降[0例(0)vs 3例(10%)],差异有统计学意义(P<0.05)。术后反流性胆道感染发生率[2例(6.7%)vs 3例(10.0%)],差异无统计学意义(P>0.05)。结论 单向可吸收倒刺线在腹腔镜胰十二脂肠切除术胆肠吻合中的应用是安全、有效的,能够减少胆肠吻合口狭窄及胆漏的发生率。 相似文献
14.
Background: The Roux-en-Y gastric bypass (RYGBP) is now performed laparoscopically widely with low morbidity and mortality.
However, in some cases long-term adequate weight loss is not satisfied because of dilatation of the gastrojejunostomy. Therefore,
a prosthetic material and bio-membranes have been used to prevent dilatation. In this study, we used posterior rectus sheath
by laparoscopy, to evaluate feasibility and safety of the procedure. Methods: 20 Yorkshire pigs, under general anesthesia,
had a standard laparoscopic RYGBP. In addition, 10 had their gastrojejunostomy anastomosis wrapped with 2x10 cm posterior
rectus sheath. Clinical and operative outcome after operation were compared with the control group of laparoscopic RYGBP cases.
Results: The median weight of the pigs was 46.1 kg (range 42-51) in the posterior rectus sheath-applied group and 45.2 kg
(range 42-49) in the control group. All gastrojejunostomies in the posterior rectus sheath-applied group were successfully
reinforced laparoscopically. Both groups loss weight compared with their normal growth weight, but there was no significant
difference in the median weight loss between the two groups. Two pigs in the posterior rectus sheath-applied group developed
a stenosis at the gastrojejunostomy anastomosis following RYGBP. All pigs in the posterior rectus sheath-applied group were
found to develop hypertrophic smooth muscle and connective tissue scarring at the gastrojejunostomy on histologic examination.
Conclusion: Laparoscopic application of posterior rectus sheath around the gastrojejunostomy in laparoscopic RYGBP is feasible
and safe. The sheath-applied group developed stenosis and connective tissue scarring. Additional research is needed to evaluate
effectiveness in preventing dilation of the anastomosis. 相似文献
15.
Open vs Laparoscopic Roux-en-Y Gastric Bypass: Comparison of Operative Morbidity and Mortality 总被引:3,自引:1,他引:2
Background: Open Roux-en-Y gastric bypass (RYGBP) has proven to be an effective method for weight control for the morbidly
obese patient. With technologic and surgical skill advancement in the application of laparoscopic surgery, laparoscopic RYGBP
has also been found to be of value in surgical control of obesity. Risk/benefit ratios in comparison of the 2 methods are
undergoing definition by experience. Methods: 779 patients who underwent RYGBP between March 1, 2000 and June 30, 2002 were
evaluated retrospectively. 328 patients underwent laparoscopic RYGBP (Group A) and 451 underwent open RYGBP (Group B). All
charts and hospital records of these patients were reviewed. Questionnaires were mailed to all patients who had undergone
RYGBP. Follow-up was 5-29 months. Results: 89 patients in Group A and 162 patients in Group B experienced significant morbidity.
There were no surgical deaths in Group A and one surgical death in Group B.Weight loss profiles were the same. Significant
differences in morbidity were noted with respect to gastrojejunal stenosis (Group A = 11.6%, Group B = 4.7%, P=.0012), occurrence of ventral incisonal hernia (A=0%, B=10%, P<.00013), and wound problems (abdominal wall hematoma A=1.5%%, B=0%, P=.013; wound infection A=1.2%, B=6.2%, P=.00037). Gastrojejunal perforation was not significantly different (A=1.5%, B=0.89%, P=.50), as was true of small bowel obstruction (A=2.7%, B=3.3%, P=.68). Conclusions: Each operative approach has associated problems.Wound care problems and ventral hernias are more common
in Group B (open) and anas tomotic stenoses are more common in Group A (laparoscopic). Anastomotic leaks and small bowel obstruction
are troublesome but not statistically different in occurrence. 相似文献
16.
Current widespread application of laparoscopic techniques in Roux-en-Y gastric bypass (RYGBP) is making surgical safety an
increasingly important issue. We report one case that resulted in death due to postoperative fulminant acute pancreatitis
after laparoscopic RYGBP was performed when this procedure was still relatively new in China. The patient was a chronically
obese 19-year-old male. Weight loss medications had been ineffective, and preoperative body mass index was 40.7. Preoperative
examination revealed moderate steatohepatitis. Laparoscopic RYGBP (LRYGBP) was performed. Early manifestations of clinical
shock appeared 13 h after the laparoscopic surgery. A second laparoscopic examination showed small-vessel hemorrhage at the
posterior wall of the jejunojejunal anastomosis, with blood clot formation resulting in Roux limb and afferent loop obstruction.
Fulminant acute pancreatitis developed in the patient 18 h after the second surgery. The patient died 15 days later from systemic
multiorgan insufficiency. LRYGBP (postcolon) is a technically demanding procedure for surgeons who are not experienced in
this operation. In addition, surgical tolerance is reduced in morbidly obese patients. Therefore, special care should be taken
during surgery, and hemostasis must be achieved at all bleeding sites. Increased perioperative surveillance allows for early
detection and management of severe complications. 相似文献
17.
Gill IS Cherullo EE Steinberg A Desai MM Abreu SC Ng C Kaouk JH 《The Journal of urology》2004,171(3):1227-1230
PURPOSE: Ureterocalicostomy is a reconstructive option in the rare patient with surgically failed or difficult ureteropelvic junction (UPJ) obstruction with fibrosis and significant hydronephrosis. We introduce the technique of laparoscopic ureterocalicostomy. MATERIALS AND METHODS: Laparoscopic ureterocalicostomy was performed in 2 patients, of whom 1 had UPJ obstruction and multiple secondary calculi in a dilated, dependent lower pole calix, and 1 had surgically failed UPJ obstruction with a scarred pelvis and significant hydronephrosis. Using a transperitoneal technique the UPJ was dismembered and suture ligated, the cut end of the ureter was spatulated, the attenuated lower pole renal parenchyma was amputated and mucosa-to-mucosa ureterocaliceal anastomosis was performed with running 4-zero absorbable suture over a stent. In the first case 32 renal calculi were also removed using a combination of laparoscopic nephroscopy and intraoperative ultrasonography. RESULTS: In cases 1 and 2 operative time was 5.2 and 2.5 hours, estimated blood loss was 200 and 75 cc, and hospital stay was 2 days, respectively. There were no intraoperative complications. The stent was removed at 8 and 5 weeks, respectively. Postoperative retrograde pyelogram and diuretic renal scan confirmed anastomotic patency and improved drainage in each patient. At 9 months patient 1 remains without flank symptoms and a second renal scan at 6 months showed further improvement in drainage. Patient 2, who continued to be symptomatic with flank discomfort despite objective improvement in drainage parameters, elected secondary nephrectomy at 6 months. CONCLUSIONS: Laparoscopic ureterocalicostomy is feasible and it effectively duplicates established open surgical principles. To our knowledge the initial experience in the literature is presented. 相似文献
18.
完全腹腔镜Roux-en-Y吻合术治疗先天性胆总管囊肿 总被引:1,自引:0,他引:1
目的探讨完全腹腔镜下Roux-en-Y吻合术治疗先天性胆总管囊肿的可行性。方法 2011年3~9月,对6例先天性胆总管囊肿行完全腹腔镜下Roux-en-Y吻合术。术中常规切除胆囊,游离囊肿壁,于正常肝总管交界处离断。距十二指肠悬韧带15~20 cm处切断空肠,于断端远端下方约50 cm处用腔镜直线切割吻合器行肠肠吻合,镜下用3-0可吸收线行肝总管-空肠端侧吻合。结果手术均获成功。术后随访3~9个月,平均5.5月,无出血、胆漏、吻合口狭窄、肠漏、腹腔脓肿、逆行感染等并发症发生。结论完全腹腔镜Roux-en-Y吻合术治疗先天性胆总管囊肿是可行的,并且具有切口小、术后腹壁瘢痕小、创伤轻、美观等微创特点。 相似文献
19.
Finley DS Perer E Eichel L Clayman RV 《Journal of endourology / Endourological Society》2005,19(6):726-729
A 48 year-old woman with pyelonephritis was found to have bilateral ureteropelvic junction (UPJ) obstruction and a nonfunctioning right kidney. She initially underwent a laparoscopic left nondismembered pyeloplasty using absorbable polydioxanone Lapra-Ty suture clips (Ethicon Endosurgery, Cincinnati, OH) to secure the anastomosis. An antegrade endopyelotomy was later necessitated. Both procedures were complicated by postoperative bacteruria and funguria. She then underwent a laparoscopic dismembered pyeloplasty, again utilizing Lapra-Ty suture clips to secure the anastomosis. Postoperatively, her course was complicated by anastomotic extravasation, bacteriuria, and funguria. Subsequently, an antegrade nephrostogram revealed a 2.5-cm diverticulum just distal to the UPJ, which contained numerous 2- to 4-mm filling defects. Nephroscopic exploration of the pseudodiverticulum revealed numerous Lapra-Ty clips, which were basket extracted. The pseudodiverticulum was fulgurated with a holmium laser. She eventually had restricturing with recurrence of the pseudodiverticulum and was treated successfully by open ureterocalicostomy. 相似文献
20.
Small-bowel obstruction secondary to internal hernia is a known postoperative complication of laparoscopic Roux-en-Y gastric
bypass (RYGBP). Petersen's defect is the most common site of postoperative internal herniation. The authors describe their
technique of closure of the infracolic component of the Petersen's defect using continuous non-absorbable suture material.
The method has been used successfully to reduce the incidence of internal herniation after laparoscopic RYGBP. 相似文献