Are Laparoscopic Gastric Bypass After Gastroplasty and Primary Laparoscopic Gastric Bypass Similar in Terms of Results?

Background  

This retrospective study compares the results of primary gastric bypass (PGB) versus secondary gastric bypass (SGB) performed after gastroplasty.     

Sympathetic chain clipping for hyperhidrosis is not a reversible procedure

Background  

Many techniques have been used to treat palmar hyperhidrosis. Compensatory sweating is a difficult adverse effect. Clipping has been proposed because of its supposed reversibility when clips are removed at a later date. The primary aims of this article are to investigate the neuronal lesion of the sympathetic chain caused by clipping and to study the possibility of regeneration after removal of the clips.     

Computed tomography appearance of Hem-o-lok clips in patients who have undergone laparoscopic nephrectomy or nephroureterectomy

Background and Objectives:

Hem-o-lok clips are safe and reliable for controlling the renal vasculature. We retrospectively evaluated the CT appearance of Hem-o-lok clips in patients who had undergone laparoscopic radical nephrectomy (LRN) or nephroureterectomy (LRU) as well as their appearance on ex vivo CT scans.

Methods:

Between January 2006 and December 2006, 19 patients underwent LRN or LRU, and their CT images were reviewed within 5 postoperative months. The Hem-o-lok clips were radiopaque in all of the patients’ CT images, and their radiodensity value was 222 Hounsfield Units (HU). To confirm that Hem-o-lok clips are radiopaque on CT images, an ex vivo CT scan was performed.

Results:

We confirmed that these clips are radiopaque on CT images and that they have a radiodensity of 223 HU.

Conclusion:

We conclude that the Hem-o-lok clips are radiopaque on CT images. It is important for urologists and radiologists to be aware of the CT appearance of Hem-o-lok clips when following up patients who have undergone LRN or LRU.     

Hilar closure using staplers or Hem-o-lok clips in a rabbit model

Background

Lung lobectomy is necessary in neonatal patients for the treatment of a variety of congenital bronchopulmonary malformations. The working space required for traditional stapling devices limits their use in pediatric video-assisted thoracoscopic (VATS) lung lobectomy. The use of Hem-o-lok clips (Teleflex Medical Inc. Research Triangle Park, NC) has been described for a number of applications in minimally invasive surgery and may provide an alternative to traditional stapling devices for bronchial closure.

Materials and methods

Twenty-four New Zealand White rabbits were used in the study. The hilus of each cranial lung lobe was sealed with the Endo GIA (Covidien Inc, Mansfield, MA) stapler or 2 Hem-o-lok clips and the lung lobe was removed. Lung inflation to leakage point was induced by incrementally increasing tidal volume. Side of leakage, volume at leakage, and airway pressure before leakage were recorded.

Results

Fourteen rabbits were included in the data analysis. Leakage of air was first observed at the Hem-o-lok closure site in five rabbits and from the Endo GIA site in three rabbits. In the remaining six, both resection sites leaked simultaneously. The mean pressure before failure was 16.39 ± 7.35 mm Hg for the Hem-o-lok clips, 17.98 ± 11.12 mm Hg for the Endo GIA stapler, and 16.95 ± 3.48 mm Hg for the simultaneous failures. No statistical differences were detected in airways pressures before leakage between hilar closure devices.

Conclusions

Despite advances in VATS, options for bronchial closure in pediatric patients undergoing VATS lung lobectomy remain limited. Hem-o-lok clips require less working space than traditional stapling devices and may represent an equally efficacious alternative to traditional stapling devices.     

Large Bariatric-Specific Stents and Over-the-Scope Clips in the Management of Post-Bariatric Surgery Leaks

Background

Endoscopic stents are successful in the management of surgical leaks; however, stent migration remains a significant problem. In this study, we present our approach depending on a large bariatrics-specific stent (Mega stent) and over-the-scope clips in the management of post-bariatric surgery leaks.

Methods

A retrospective analysis of all patients with post-bariatric surgery leaks treated at our institution using an approach reliant on Mega stents and over-the-scope clips was conducted. Potential factors associated with procedure success and occurrence of complications were also evaluated.

Results

A total of 81 stents were inserted in 62 patients with post-bariatric surgery leaks, 46 sleeve gastrectomies (73%) and 16 Roux-en-Y gastric bypass (27%). Over-the-scope clips were applied in 29 patients (46%). Leak closure was achieved in 51 patients (82%). Median number of procedures per patient was 3 (range 2–8). Complications included the following: stent migration (11/62, 18%), intolerance necessitating premature removal (7/62, 11%), esophageal stricture (8/62, 13%), bleeding (4/62, 6%), perforation (4/62, 6%). One stent-induced mortality was encountered (bleeding). The presence of open surgery (vs laparoscopic) was significantly associated with the occurrence of stent-induced complications (p 0.002).

Conclusion

The approach combining Mega stents and over-the-scope clips is highly effective in the management of post-bariatric surgery leaks and is associated with a low rate of stent migration and a low number of procedures and stents per patient. Mega stents, however, should be used with great caution due to the significant morbidity associated with their use.

     

Quality assurance in flexible sigmoidoscopy: medical and nonmedical endoscopists

Purpose  

The clinical assessment of position in colon and hence completion during flexible sigmoidoscopy (FS) is believed to be inaccurate. The technique of applying endomucosal clips with follow-up X-ray has previously been used for establishing completion in colonoscopy. Furthermore, we have now trained non-healthcare professionals (non-medical endoscopists, NME) to perform FS, but there is no data on assessment of their performance of FS. We performed this study with the aims of determining accuracy of endoscopists’ clinical impression regarding actual position of endoscope in colon during FS, comparing medical (ME) and NME in terms of clinical accuracy, and to determine role of endomucosal clips with follow-up X-rays in documenting completion and hence quality assurance.     

Appendix stump closure with titanium clips in laparoscopic appendectomy

Purpose  

Different techniques, including clips, have been used to close the stump in laparoscopic appendectomy. The aim was to investigate the results after application of a newly developed titanium clip for this operation.     

Excision of sympathetic ganglia and the rami communicantes with histological confirmation offers better early and late outcomes in Video assisted thoracoscopic sympathectomy

Background  

Video-Assisted Thoracoscopic Sympathectomy (VATS) is an established minimally invasive procedure for thoracic sympathetic blockade in patients with hyperhidrosis, facial flushing and intractable angina. Various techniques using clips, diathermy and excision are used to perform sympathectomy. We present our technique of excision of the sympathetic chain with histological proof and the analysis of the early and late outcomes.     

Conversion from Band to Bypass in Two Steps Reduces the Risk for Anastomotic Strictures

Background  

Morbidity after converting failed laparoscopic adjustable gastric banding (LAGB) to laparoscopic Roux-en-Y gastric bypass (LRYGB) is three- to fivefold higher than after primary LRYGB. Allowing a time interval between band removal and actual gastric bypass might reduce local inflammation and reduce morbidity.     

Ten years after arterial bypass surgery for claudication: venous bypass is the primary procedure for TASC C and D lesions

Background  

The appropriate role for surgery and endovascular therapy for severe intermittent claudication (IC) remains controversial. We present our results after infrainguinal autogenous bypass for severe IC more than 10 years ago giving a reasoned argument to perform vein bypass as the primary procedure for severe IC.     

The Effect of Duodenal–Jejunal Bypass on Glucose-Dependent Insulinotropic Polypeptide Secretion in Wistar Rats

Background  

Enteroendocrine K cells secrete the incretin hormone glucose-dependent insulinotropic peptide (GIP) and are predominately located in the duodenum. GIP levels should decrease after gastric bypass due to duodenal exclusion; however, studies have found conflicting data regarding the changes in GIP secretion after gastric bypass and duodenal–jejunal bypass (DJB).     

Stent placement provides safe esophageal closure in thoracic NOTESTM procedures

Background  

Safe esophageal closure remains a challenge in transesophageal Natural Orifice Transluminal Endoscopic Surgery (NOTES). Previously described methods, such as suturing devices, clips, or submucosal tunneling, all have weaknesses. In this survival animal series, we demonstrate safe esophageal closure with a prototype retrievable, antimigration stent.     

Laparoscopic conversion of Roux-en-Y gastric bypass to biliopancreatic diversion

Background  

This report describes the laparoscopic conversion of a Roux-en-Y gastric bypass (RYGBP) to biliopancreatic diversion (BPD).     

Psychological Correlates of Laparoscopic Adjustable Gastric Band and Gastric Bypass Patients

Background  

To compare psychological characteristics of patients seeking laparoscopic adjustable gastric band (LAGB) and gastric bypass surgery.     

Enhanced Intracellular Heat Shock Protein 70 Expression of Leukocytes and Serum Interleukins Release: Comparison of On-pump and Off-pump Coronary Artery Surgery

Background  

Coronary artery bypass grafting (CABG) employing cardiopulmonary bypass (CPB; “on-pump” technique) is known to induce a systemic inflammatory response and heat-shock protein 70 kDa (HSP70) expression. The objective of the present study was to investigate the perioperative intracellular HSP70 expression of leukocytes and serum interleukin (IL) release in CABG conducted with both on-pump and off-pump techniques.     

The Outcome of the Axillofemoral Bypass: A Retrospective Analysis of 45 Patients

Purpose  

This study was designed to retrospectively analyze outcomes of axillofemoral bypass (AxFB) operations performed in patients with severe comorbidities.     

Metabolic and Hormonal Changes After Laparoscopic Roux-en-Y Gastric Bypass and Sleeve Gastrectomy: a Randomized,Prospective Trial

Background  

The mechanisms of amelioration of glycemic control early after laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) are not fully understood.     

Morbidity associated with systemic corticosteroid preparation for coronary artery bypass grafting in patients with chronic obstructive pulmonary disease: a case control study

Background  

Coronary artery bypass grafting (CABG) is associated with high morbidity in patients with chronic obstructive pulmonary disease (COPD).     

Zinc Deficiency: A Frequent and Underestimated Complication After Bariatric Surgery

Background  

Although zinc deficiency is common after bariatric surgery, its incidence is underestimated. The objective was to monitor zinc and nutritional status before and 6, 12 and 24 months (M6, M12 and M24) after gastric bypass (Roux-en-Y gastric bypass), sleeve gastrectomy and biliopancreatic diversion with duodenal switch (DS) in patients receiving systematised nutritional care.     

Cognitive outcome after EC-IC bypass surgery in hemodynamic cerebral ischemia

Objective  

The purpose of this study was to evaluate cognitive functions in patients undergoing extracranial-intracranial (EC-IC) bypass surgery for cerebral ischemia.