Vertical Isolated Gastroplasty with Gastro-enteral Bypass: Preliminary Results

Background: The authors present a new restrictive and malabsorptive operation for treatment of morbid obesity, called vertical isolated gastroplasty (VIG). Methods: From Feb 2004 to May 2005, 30 patients with BMI ≥40 kg/m² or >35 kg/m² with co-morbidities underwent VIG via laparoscopy or laparotomy. The technique consisted in creation of a gastric tube preserving pylorus, and a Roux-limb of 300 cm to the bypassed stomach with the division 30 cm distal to the ligament of Treitz. Excess weight loss (EWL), BMI, complications and co-morbidities were assessed. Results: BMI and average preoperative weight were 41.2 kg/m² and 110.7 kg, respectively. At 12 months postoperatively, BMI and average weight were 23.4 kg/m² and 65.1 kg, respectively, with EWL 90.2%. None of the patients presented dumping. Improvement in co-morbidities was >90%. Complications consisted of: 1 dehiscence of gastric sutureline, 1 hemoperitoneum, 1 gastroenterostomy ulcer, 1 anemia of undetermined cause, and 3 cholelithiasis. There was no mortality. Conclusion: VIG has thus far been safe and effective, with the same results as other bariatric operations. VIG has certain advantages, such as lack of dumping and lack of clinically significant stenosis of the gastroenterostomy, which can occur with other techniques. Because a duodenal bypass is not performed, it allows physiologic absorption of iron and diagnostic and/or therapeutic access to the ampulla of Vater.     

Laparoscopic Standard Biliopancreatic Diversion: Technique and Preliminary Results

Background: A technique for standard laparoscopic BPD was developed. Methods: Standard laparoscopic BPD was performed in 26 morbidly obese patients with mean BMI 43. Details of the technique, using 6 trocars, and instrumentation are described. Intestinal limb lengths were measured fully stretched, and the gastric remnant volume was also measured. Both enteroenteral and gastrointestinal anastomoses were fashioned with a side-to-side technique using the endoGIA, the conjoined defect being closed with a manual running seromuscular suture. Results: 6 and 12 month weight loss results were similar to those obtained in open BPD. Conclusion: Laparoscopic standard BPD is a feasible alternative to the open operative procedure, the major advantage being the likely near total avoidance of wound hernia.     

Long-Term Results of Ureterosigmoidostomy in Children With Bladder Exstrophy

Purpose

We evaluated long-term results of patients with bladder exstrophy who underwent ureterosigmoidostomy.

Materials and Methods

Of 4 women and 23 men monitored at our institution 16 (59 percent) underwent primary diversion by ureterosigmoidostomy, while 11 (41 percent) underwent primary bladder closure or an ileal conduit procedure before conversion to ureterosigmoidostomy. Average followup after ureterosigmoidostomy was 17 years.

Results

Significant upper urinary tract changes developed in 18 percent of the patients. Metabolic acidosis was well compensated in most patients but 2 had problems with urinary retention leading to hyperammonemia and acidosis. Of the 19 patients monitored with biennial colonoscopy benign polyps were removed in 4. Daytime continence was achieved in 92 percent of cases and nighttime continence in 58 percent.

Conclusions

Our experience with ureterosigmoidostomy in children with bladder exstrophy has been favorable through long-term followup. With proper imaging, metabolic surveillance, biennial colonoscopy and nonsteroidal anti-inflammatory drugs we offer ureterosigmoidostomy as a viable alternative for patients with small bladders.     

Laparoscopic Sleeve Gastrectomy with Duodenojejunal Bypass: Technique and Preliminary Results

Background  

Obesity and metabolic disorders related to it have become a serious problem in Asia. Furthermore, gastric cancer in Asia is one of the frequent diseases on which to perform treatments. We introduced the technique of laparoscopic sleeve gastrectomy with duodenojejunal bypass (LSG/DJB) for patients with a risk of gastric cancer and compared the results of our initial series with those of other procedures.     

The Swedish Adjustable Gastric Band: Laparoscopic Technique and Preliminary Results

Background: The laparoscopic technique for the Swedish Adjustable Gastric Band (SAGB) has been developed based on the previously established open technique. Methods: From March 1996-June 1997, laparoscopic SAGB was attempted in 85 consecutive obese patients (77 women and 8 men). The average preoperative BMI was 44 (34-59). Results: All operations except one were completed by laparoscopy. One patient had to be converted because of unfavorable anatomic conditions. The average operating time was 40 minutes.There were no immediate perioperative complications. All patients were followed for 1 year. During this period 2 patients developed esophagitis and 3 patients experienced repeated vomiting. There were no other complications. At 1 year follow-up the average BMI was 33 (21-46).The excess weight loss was 54% (17-100%). Conclusion: Early results are encouraging. No significant complications related to the technique were registered. One-year weight loss was equal to what was achieved by open surgery. Laparoscopic SAGB will be established as an attractive alternative for surgical treatment of morbid obesity.     

Annular Enlargement During Aortic Valve Replacement: Preliminary Results with a Simplified Technique

A simplified technique has been used to enlarge the aortic annulus in a series of 13 patients undergoing aortic valve replacement. The procedure basically consists of extending the aortotomy incision into the aortic annulus by dividing the commissure between the left and noncoronary sinuses, without involving the anterior mitral leaflet. Wide opening of the commissure is obtained and the resulting defect is closed, preferably using a patch of bovine pericardium sutured to the mitral annulus and aortic wall. This technique is simple, reproducible, avoids opening of the left atrium (reducing the potential bleeding sites), allows insertion of a prosthesis at least two sizes larger than the original annulus, and is also applicable in cases of mitral-aortic valve replacement. Our preliminary results are satisfactory and seem to demonstrate that in many patients, even in the young age group, more complex procedures are often unnecessary when enlargement of the aortic annulus is required.     

Data Quality in Institutional Arthroplasty Registries: Description of a Model of Validation and Report of Preliminary Results

Background

Arthroplasty registries are a relevant source of information for research and quality improvement in patient care and its value depends on the quality of the recorded data. The purpose of this study is to describe a model of validation and present the findings of validation of an Institutional Arthroplasty Registry (IAR).

Detubularized sigmoid reservoir for bladder replacement after cystoprostatectomy: Preliminary report of new configuration

A technique for total bladder replacement using a detubularized sigmoid segment is described. The procedure is technically straightforward and results in a highly compliant, low-pressure reservoir that allows both day and night-time continence.     

Laparoscopic Sleeve Gastrectomy with an Extensive Posterior Mobilization: Technique and Preliminary Results

Background  

Laparoscopic sleeve gastrectomy (LSG) is becoming increasingly popular as a stand-alone procedure for the treatment of morbidly obese patients. A direct posterior approach to the angle of His was developed at our department to improve visualization of the difficult dissection of the short gastric vessels and to facilitate proper mobilization of the stomach around the left crus enabling safe realization of a tight sleeve. The technique and its preliminary results are described.     

Laparoscopic Adjustable Pyloric Band with Fundoplication in Bariatric Surgery: Technique and Preliminary Results

Background Laparoscopic biliopancreatic diversion according to Scopinaro is an extremely effective operation for weight loss, but carries significant morbidity in terms of metabolic deficiencies. Methods A study was conducted as to the feasibility, safety and efficiency of a novel procedure, accomplishing a ‘reversible Scopinaro BPD’, performed in two stages: first the placement of an adjustable band in a juxtapyloric position, aiming at maintaining postprandial satiety, and second, the construction of a transmesocolic Roux-en-Y gastro-enterostomy with a 2.5-m long distal jejunal limb, reanastomosed 50 cm proximal to the ileocecal valve. Results 15 patients, mean BMI 38.9, 8 males and 7 females, underwent the first stage of pyloric adjustable banding. All benefited at the same time from a Nissen fundoplication, to avoid gastroesophageal reflux. 1 patient was withdrawn from the study at this stage because of peritonitis of unknown cause and removal of the band. 3 patients benefited from the second stage of the operation because of insufficient weight loss, and/or symptoms of gastric stasis. 1 patient developed diarrhea and was treated by peroral cholestyramine.Weight loss was similar to the regular BPD figures. Conclusion The placement of an adjustable gastric band in a juxtapyloric position, combined with a Nissen fundoplication, appears to be a safe and efficient satiety-inducing operation. In case of insufficient weight loss, and/or exaggerated gastric stasis, a Scopinaro BPD construction can be added to the otherwise unharmed stomach, hereby constituting an instantly reversible malabsorptive component.     

肘关节"恐怖三联征"的手术治疗-改良手术技术及初步结果报道

目的 总结肱尺关节后脱位合并桡骨头和尺骨冠状突骨折的手术治疗体会.方法 回顾5例典型肘关节"恐怖三联征"的手术治疗结果.手术方法包括:经肘关节外侧入路予桡骨头骨折内固定、修补外侧副韧带及伸肌总腱止点.经肘关节内侧径路固定尺骨冠状突,修复肘关节周围关节囊和内外侧副韧带损伤.最后使用肘关节铰链式外固定支架固定肱尺关节脱位,恢复肘关节同心圆稳定性.于术后1、3、6个月及随访结束时,进行影像学和临床检查评估.结果 5例平均手术时间为76 min(60-150 min),平均随访时间8.8个月(3-13个月).外固定支架拆除时间6周(4-9周).至随访末患者肘关节活动度平均为(127±25)°.按照Mayo肘关节评分平均为87分(80-95分),优2例,良3例.无浅表或深部感染、皮肤无坏死、无骨化性肌炎等并发症.结论 通过手术内固定或修补肘关节稳定结构结合外固定支架维持肘关节同心圆解剖关系可以明显改善肘关节"恐怖三联征"患者肘关节的功能及预后,对此类损伤建议采用内固定结合外固定治疗.