Laparoscopic inflatable band with Roux-en-Y gastric bypass

Background: Roux-en-Y gastric bypass (RYGBP) leaves a large blind gastric segment, which is inaccessible for conventional endoscopy. Method: A case is reported, describing a variation of laparoscopic RYGBP by partitioning the stomach by an inflatable band rather than by stapling or division. Results:The stomach was partitioned into a proximal 15 cc pouch and a distal part by an adjustable gastric band. A RYGBP was fashioned from the proximal pouch. 9 patients were treated with this technique: 7 as an initial procedure and 2 after previous gastric banding which had been followed by insufficient weight loss. 1 of these latter patients developed erosion of the band through the gastrojejunostomy 7 months postoperatively. Conclusion: Laparoscopic proximal RYGBP with inflatable-band gastric partitioning is feasible. Erosion of the band though the gastrojejunostomy, however, might be a serious side-effect of this technique.     

Ethanol diffuses across the gastric muscle wall

Ethanol inhibits the electrical and mechanical activities of gastric smooth muscle, but only at concentrations higher than can be provided by serum delivery. We speculated that the ethanol concentration in the gastric wall may exceed plasma levels by direct diffusion across the mucosa and through the muscle layers. A model of acute ethanol ingestion was created by partitioning the stomachs of three dogs with a surgical stapling device and instilling carbon 14 (14C)-labeled ethanol into the proximal segments. The flux of ethanol was traced by counting 14C in serial sections of the gastric wall. A mucosa-to-serosa gradient of 14C activity was established. The data indicate that direct diffusion from the mucosal surface will produce dramatically higher concentrations of ethanol in gastric muscle than would be anticipated from serum levels alone.     

Schwannoma of the stomach with elevated preoperative serum carbohydrate antigen 19-9: report of a case

We herein report a case of a gastric schwannoma with elevated preoperative serum carbohydrate antigen 19-9 (CA19-9) (155.2 U/ml, normal range 0-36.9 U/ml). A 59-year-old Japanese man was admitted to our hospital for treatment of a submucosal tumor of the stomach detected by barium meal, upper gastrointestinal endoscopy, and computed tomography. Endoscopic examination revealed a 3-cm diameter submucosal tumor in the antrum of the stomach, but biopsy of the lesion was unable to confirm the diagnosis. Positron emission tomography to evaluate the malignant potential showed a high uptake of (18)F-fluorodeoxyglucose in the tumor. Laparoscopy-assisted distal gastrectomy was therefore performed. The histopathological findings of the surgical specimen revealed a benign gastric schwannoma, positive for S-100 protein. The postoperative serum CA19-9 levels gradually decreased and normalized. To the best of our knowledge, this is the first report of a gastric schwannoma with elevated serum CA19-9.     

Effects of partitioning operations on the electrical activity of the human stomach

To identify the effects that various gastric partitioning procedures have on the electrical activity of the stomach, pairs of bipolar Teflon-coated electrode wires were placed in selected sites of the stomach of 18 patients. Recordings from the proximal gastric fundus above the staple line, from the distal fundus below the staple line, and from the distal gastric antrum were obtained using differential preamplifiers, an oscilloscope, and a dual-channel tape recorder. Oscilloscopic displays were photographed and the electrical signals were recorded for subsequent analysis. The total number of readings at each recording site were: proximal fundus, 79; distal fundus, 59; and antrum, 96. Control electrical rhythm (CER) was found in all the 96 antral recordings. The mean period was 21.6 ± 0.22 sec (SEM). The frequency was 2.8 ± 0.03/min. Only in 4 of the 138 recordings from the gastric fundus, could a low-amplitude CER be identified. Although partitioning of the stomach by stapling produces some degree of crushing injury to the gastric wall, no abnormalities of the CER were noted in the antrum, supporting the concept that the gastric pacemaker of the slow-wave electrical activity (CER) in the human stomach is located below the gastric fundus. Furthermore, in contrast to cardiac muscle, localized mechanical injury to the gastric wall did not result in ectopic foci of electrical activity.     

Comparison of Anterior Gastric Wall and Greater Gastric Curvature Invaginations for Weight Loss in Rats

BACKGROUND: Many bariatric endoscopic or surgical procedures performed today reduce gastric capacity and/or induce an early sensation of gastric satiety, alone or in combination with a distal enteric intervention. A form of prosthetic wrap of the folded stomach was used in the past for treating obesity with a high rate of prosthesis-related reintervention. Nissen gastric fundoplication used in the treatment of gastroesophageal reflux disease induces a small but significant weight loss without gastric stapling, partitioning, or prosthesis-related morbidity. We recently reported greater gastric curvature invagination without stapling, partitioning or prosthesis use, for weight loss in rats. We now compare anterior gastric wall and greater gastric curvature invaginations for weight loss. The anterior invagination would be technically easier, should it be tested in humans. METHODS: 20 rats were randomized in 2 groups. The anterior gastric wall of 10 rats was invaginated in the first group (AGW). The greater gastric curvature of 10 rats was invaginated in the second group (GGC). All animals were weighed weekly for 4 weeks. They were then autopsied on the 28th day. RESULTS: The mean body weight of the GGC group became statistically less than the AGW group at 21 days. The mean weight of the peritesticular fat pad and the mean gastric volume were not statistically different at 28 days (autopsy). CONCLUSION: Greater gastric curvature invagination significantly reduces body weight compared to anterior gastric wall invagination at 21 days.     

Cancer in the gastric remnant after gastric bypass: a case report

Gastric cancer in the gastric stump after a Bilroth II subtotal gastrectomy is a well-recognized entity. However, gastric cancer in the bypassed gastric remnant after a gastric bypass operation for morbid obesity has not been well described, and only 2 such cases have been reported in the English literature. This case report presents a patient who developed gastric cancer in the defunctionalized, bypassed stomach 22 years after undergoing an open gastric bypass with a Roux-en-Y gastro-jejunostomy for morbid obesity. The problems of monitoring the defunctionalized bypassed stomach after gastric stapling and gastro-jejunostomy are discussed.     

Laparoscopic distal gastrectomy with regional lymph node dissection for gastric cancer

Recently, a minimally invasive operation for gastric malignancies has been advocated, and the laparoscopic operation is noted as a technique that increases the quality of life. We performed distal gastrectomy with regional lymph node dissection on 160 cases of gastric cancer located in the middle or lower third of the stomach. In 123 cases, Billroth I reconstruction was performed intracorporeally using the quadrilateral (square) stapling technique with a laparoscopic linear stapling device to prevent postoperative anastomotic bleeding and stenosis. In the remaining 37 cases, the Billroth II method was performed with a linear stapling device [1]. This technique is not only less invasive but also as safe as open gastrectomy, which was performed on 100 gastric cancer cases of similar staging.     

Benign nerve sheath tumor of stomach

Gastrointestinal mesenchymal tumors are a group of tumors, which originate from the mesenchymal stem cells of the gastrointestinal tract. Gastric schwannoma is a very rare gastrointestinal mesenchymal tumor, which represents only 0.2% of all gastric tumors and 4% of all benign gastric neoplasms. We report a 55 years old lady who suffered from pain epigastrium, vomiting, occasionally with blood, loss of appetite and weight loss. Endoscopic examination showed a round submucosal tumor with a central ulceration along the greater curvature of the stomach. The pathological examination revealed a picture of spindle cell tumor. Immunohistochemical stain was strongly positive for S-100 protein stain, and non-reactive for CD34, CD117, consistent with benign nerve sheath tumor of stomach i.e. gastric schwannoma.     

Gastric Schwannomas show an obviously increased fluorodeoxyglucose uptake in positron emission tomography: Report of two cases

Schwannomas are tumors originating from any nerve that has a Schwann cell sheath. Gastrointestinal (GI) schwannomas represent only 3% of all GI mesenchymal tumors. The stomach is the most common site of GI schwannomas, and schwannomas account for 0.2% of all gastric neoplasms. This report presents two cases of gastric schwannomas showing increased [18F]fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET; maximum standardized uptake value 7.10 and 6.05). Additional immunohistochemical staining of glucose transporter type 1 (GLUT1) and the autocrine motility factor (AMF) was conducted after the tumors were resected, to identify the mechanism that increased FDG uptake on PET. Immunohistochemical expression of AMF was positive in both cases, whereas GLUT1 was negative. Autocrine motility factor is also known as phosphoglucose isomerase. However, the mechanism by which FDG is accumulated in schwannoma cells is uncertain, and may be related to intracellular glycolytic activity.     

胃神经鞘瘤:附9例报告

目的 分析胃神经鞘瘤的临床特点、诊断和治疗方法。方法 回顾分析笔者近15年来收治的9例胃神经鞘瘤的临床资料。结果 临床主要表现是上腹部隐痛(9例)、腹部肿块(5例)和上消化道出血(3例)。9例均手术治疗，但无1例术前确诊。1例恶性胃神经鞘瘤术后只生存了8个月，良性的手术效果良好。结论 胃神经鞘瘤无特异性临床表现，术前确诊困难，误诊率高，一经确诊，应及早手术治疗。     

胃神经鞘瘤

目的 总结胃神经鞘瘤的临床特点及治疗方法。方法 收集经我院诊治的10例胃神经鞘瘤患的资料,对其诊断及治疗作分析总结。结果 胃神经鞘瘤主要表现为腹痛、腹部肿块、黑便、上消化道出血亲休克。可通过胃镜、X线、B超等辅助检查协助诊断,确诊靠病理检查。治疗以手术为主。结论 胃神经鞘瘤无特殊临床表现,诊断困难,术前确诊率低,误诊率高。     

Port-Stapling zur Erleichterung der Portimplantation bei der laparoskopischen Magenbandoperation

BACKGROUND: The purpose of this study was to evaluate the applicability of a port stapling device to simplify and improve port implantation in laparoscopic adjustable gastric banding (LAGB). METHODS: From November 2005 to September 2006, a prospective study was conducted on 23 consecutive patients who underwent LAGB with Swedish adjustable gastric banding. Patients were randomized to either conventional titanium-port implantation or port stapling using the "Velocity" device. RESULTS: No differences in age, body weight, body mass index, fascia depth or incision length were reported between the groups. Port implantation time was significantly less using port stapling (90+/-24 s) compared to conventional port implantation (521+/-138 s). Port related complaints postoperatively and at follow-up were equal in both groups. CONCLUSIONS: Port stapling is an excellent tool to facilitate port implantation, particularly in massively obese patients with a thick abdominal wall.     

The healing and tensile strength of the gastroplasty staple line. An experimental study

Inverted and everted staple lines, with and without division of the anterior gastric wall, were performed in 15 mongrel dogs to simulate reduction gastroplasty staple line. There were no significant differences in tensile strength and healing between staple lines at different postoperative periods. The tensile strength of the inverted staple line seemed to be stronger due to breakage of the adjacent gastric tissue. However, the tensile strength of the everted stapling without division of the gastric wall, which is used clinically, was almost equal to that of normal gastric tissue. In addition, there was satisfactory healing 4 weeks postoperatively in the everted stapling without dividing the gastric wall. These results suggest that the everted staple line without division of stomach is not inherently weaker to any significant extent than if the gastric wall was divided or inverted. The reported failure rate of this procedure may be due to other factors.     

Laparoscopic excision of a gastric diverticulum in a child

Gastric diverticulum is a rare entity; the patient usually presents with vague abdominal pain, nausea, vomiting, and weight loss. Diverticulectomy is required for patients with intractable symptoms or complications. We report the laparoscopic excision of a gastric diverticulum in a 15-year-old girl who had been symptomatic for 5 years. A five-port technique and a linear cutting and stapling device were used.     

Schwannoma of Parapharyngeal Space: a Case Report

The incidence of schwannoma in the head and neck region is between 25 and 45 %. The vestibular nerve is involved in most cases followed by the parapharyngeal space. Schwannoma, also known as neurilemmoma, is a benign neoplasm that originates from the Schwann cells. These cells form the myelin sheath around myelinated peripheral axons. Here, we report a case of parapharyngeal space schwannoma in a 27-year-old female.     

A simple technique of correcting complete gastric obstruction after gastric partitioning

The use of autosuture staplers in intraabdominal surgery has become an accepted procedure for simplifying gastrointestinal surgery. Described in this report is a simple method of correcting unrelenting gastric obstruction that may occur after gastric partitioning for morbid obesity by utilizing the autosuture model EEA stapler to reestablish gastric continuity.     

Gastric schwannoma

The article presents the case study of a 78-year-old , female patient with a gastric schwannoma, with the symptoms of a superior digestive hemorrhage and secondary anemia. A surgical operation was performed and the patient was healed. The preoperative diagnosis carried out by means of echographic, endoscopic and computed tomography examinations was gastric tumour. Histopatological examination performed during the operation led to the final diagnosis of gastric schwannoma.     

Anterior gastric stapling combined with posterior truncal vagotomy: an experimental technique for gastric acid reduction

An operative technique using a mechanical stapling device has been developed to simplify proximal gastric vagotomy. A series of gastric fistula dogs underwent posterior truncal vagotomy and anterior lesser curvature stapling. The basal and pentagastrin-stimulated acid secretion was measured before surgery and 2 weeks and 3 and 9 months after surgery. During the whole period, no change in body weight was noticed. Gastric acid secretion in dogs remained low and stable during the first year after the procedure.     

全腹腔镜远端胃癌根治术(Uncut Roux-en-Y吻合)

Uncut-Roux-en-Y吻合方式顺序为:在距Treitz韧带约20 cm处的空肠对系膜缘侧打开0.5 cm切口,在残胃大弯侧残端打开0.5 cm切口,切口分别置入切割闭合器"分支"行侧侧吻合,共同开口再行切割闭合器闭合(胃肠吻合);距胃肠吻合口近端7~8 cm处及远端约30 cm处空肠对系膜缘处分别打开0.5 cm切口,分别置入切割闭合器"分支"行侧侧吻合,共同开口再行切割闭合器闭合(空肠侧侧吻合-Braun吻合);最后在距胃肠吻合口近端2~3 cm空肠处用no cut闭合器闭合的方法闭合输入袢空肠(输入袢阻断)。     

Circular stapling anastomosis (EEA) following gastrectomy

After total gastrectomy because of gastric malignancies 31 oesophagojejunostomies performed in end-to-side fashion using a standard manual technique were compared with oesophagojejunostomies performed in end-to-end fashion by mechanical stapling (EEA). After manual suturing there was a leak in 29% and 25.8% out of all patients died. After automatic mechanical suturing anastomotic failure was seen in 12.9% with a postmortality rate of 3.2%. These results show, that by mechanical stapling a secure oesophagojejunostomy is possible and the risk of gastrectomy can be reduced.