Gastric Perforation in an Obese Patient with an Intragastric Balloon,following Previous Fundoplication

Background: The Bioenterics Intragastric Balloon (BIB) has been a safe and effective method used in treatment of moderate obesity. Gastric perforation is a rare complication, and its possible sequelae are dangerous. Methods: A 52-year-old women (BMI 37 kg/m²), with hiatal hernia, moderate hypertension and dyspnea, 1 year ago underwent laparoscopic fundoplication. She now underwent positioning of a BIB^? filled with 500 cc of saline. After 8 days, 6 kg weight loss occurred and her clinical condition was satisfactory. On day 11, severe abdominal pain and vomiting occurred, which spontaneously regressed in the following 6-8 hours. Ultrasound confirmed the correct position of the BIB^?, and showed widespread abdominal meteorism. On day 18, acute abdomen with paralytic ileus occurred. On admission, CT scan documented hydropneumoperitonitis. At operation, a large perforation of the lesser curvature was found, with undigested food in the abdomen. She underwent peritoneal lavage, removal of the BIB, and suture of the gastric laceration. Results: She was discharged in good condition after 11 days. Conclusion: According to our experience, fundoplication represents an absolute contraindication to positioning of a BIB^?.     

Evaluation of Gastric Greater Curvature Invagination for Weight Loss in Rats

Background: Many bariatric endocopic or surgical procedures performed today reduce gastric capacity and/or induce an early sensation of satiety, alone or in combination with a distal enteric intervention. A form of prosthetic gastric wrap was used in the past for treating obesity with a high rate of reintervention. Nissen gastric fundoplication used in the treatment of gastroesophageal reflux disease induces a small but significant weight loss. We report the effect of gastric greater curvature invagination on weight in rats. Methods: 30 rats were randomly divided into 3 groups. 10 rats in the first group (sham) were anesthesized and weighed. The rats from the second group (lap) were in addition submitted to a laparotomy plus visceral manipulation. In the third group (inv), invagination of the greater curvature of the stomach was added. All animals were weighed on the 7th and 21st days. They were then autopsied on the 21st day. Results: The mean body weight of the invagination group became statistically less than the laparotomy and sham groups at 7 and 21 days. The mean weight of the peritesticular fat pad from the inv group was also significantly less than from the sham group but not different from the lap group. Conclusion: Gastric greater curvature invagination significantly decreases weight in rats.     

Concurrent Fluoroscopy and Manometry Reveal Differences in Laparoscopic Nissen and Anterior Fundoplication

A prospective double-blind randomized trial wasinitiated to examine two types of laparoscopicfundoplication (Nissen and anterior). Thirty-twopatients with proven gastroesophageal reflux diseasepresenting for primary laparoscopic antireflux surgerywere randomized to undergo either Nissen fundoplication(N = 13) or anterior hemifundoplication (N = 19).Postoperative fluoroscopic and manometric examinationwas carried out concomitantly. Nissenfundoplication resulted in significantly greaterelevation of resting (33.5 vs 23 mm Hg) and residuallower esophageal sphincter pressures (17 vs 6.5 mm Hg)and lower esophageal ramp pressure (26 vs 20.5 mm Hg) than theanterior partial fundoplication. A smallerradiologically measured sphincter opening diameter wasseen following Nissen fundoplication (9 mm) comparedwith anterior fundoplication (12 mm). Lower esophageal ramppressure correlated weakly (r = 0.37, P = 0.04) withpostoperative dysphagia. It is concluded that the typeof fundoplication performed significantly influences postoperative manometric and video bariumradiology outcomes. The clinical relevance of thisrequires further investigation.     

Cisapride Enhances the Effect of Partial Posterior Fundoplication on Esophageal Peristalsis in GERD Patients with Poor Esophageal Contractility

Partial posterior fundoplication improvesesophageal peristalsis in patients with gastroesophagealreflux disease (GERD) associated with poor esophagealbody function. The aim of this study was to investigate whether postoperative administration ofcisapride enhances the effect of surgery on esophagealperistalsis. Laparoscopic partial posteriorfundoplication was performed on 34 consecutive GERDpatients with poor esophageal body motility. These patientswere randomized in groups without and with postoperativetreatment with cisapride 20 mg twice daily for sixmonths. Esophageal manometry was performedpreoperatively and six months following surgery. Esophagealbody function improved significantly following partialposterior fundoplication without or with postoperativetreatment with cisapride. However, this effect was more pronounced in the group of patientsreceiving cisapride. Partial posterior fundoplicationcombined with postoperative treatment with cisaprideshould be the therapy of choice in GERD patients with poor esophageal body motility.