Background
The closure of the mesenteric defects (CMD) in Roux-en-Y gastric bypass (RYGB) reduces the risk of small bowel obstruction (SBO) due to internal hernia but might be associated with an ...increased risk of early SBO triggered by the jejunojejunal anastomosis (JJS) kinking. The aim of this study was to assess how enlarging the JJS with a bidirectional linear stapling can aid in avoiding the risk of early SBO by kinking.
Materials and Methods
This retrospective cohort study concerns 1327 patients who underwent RYGB with CMD between May 2007 and August 2016. The first 626 patients (group A) had a unidirectional JJS. The following 701 patients (group B) had a bidirectional side-to-side JJS and a hand-sewn closure of the remaining defect. We compared early SBO between the two groups.
Results
Eleven (1.75%) early SBO due to the JJS kinking occurred in group A, whereas none occurred in group B (
p
= 0.0012). Thirty-nine early postoperative complications happened in group A versus 32 in group B (
p
= 0.17). Nine (1.2%) digestive bleedings occurred in group B versus two (0.3%) in group A (OR = 4.05 0.87–18,
p
= 0.054). Average operating time was 81 min 37–330 in group A and 77 min 33–240 in group B.
Conclusion
Enlarging the JJS with a bidirectional linear stapling is associated with a reduced risk of early SBO due to the anastomosis kinking. However, it could be related to an increased risk of digestive bleedings.
Background
Surgical revision rates are high, reaching 41% at 10 years after Laparoscopic gastric band (LAGB). Surgical revision may include re-banding, laparoscopic sleeve gastrectomy (LSG), duodenal ...switch (DS), or laparoscopic Roux-en-Y gastric bypass (LRYGB). LRYGBP has been proposed as the procedure of choice after failure of restrictive procedures with better results than any other procedure. LRYGB as a revisional bariatric surgery is hazardous compared with primary LRYGB. However, controversy as to whether revisional bariatric surgery should be performed as a one-step revision or as a two-step revision.
Objective
We aim to compare the mortality and morbidity between one-step versus two-step revisional surgery from LAGB to LRYGB.
Materials and Methods
Retrospective cohort study of our revisional surgery from LAGB to LRYGB between November 2007 and December 2016. Revisional surgery was indicated in cases of inadequate weight loss or weight regain and after band-related complications. Gastric band removal and conversion to LRYGB was either in a one-step or a two-step procedure, according to the indication of this revisional surgery and based on the intra-operative decision.
Results
One-step group included 107 patients, two-step group had 76 patients.
Minor Complications
Dindo-Clavien I-II: 5 complication in the one-step group, whereas 4 complication were seen in the two-step group (
P
= 1.000).
Major Complications
Dindo-Clavien ≥ IIIa complications: 10 complication in the one-step group, whereas 2 complications in the two-step group (
P
= 0.127).
Conclusion
One-step revision is safe and feasible, without significant increased morbidity when performed in a specialized institution. However, proper patient selection is of the utmost importance.
In addition to attacking the respiratory system, the coronavirus disease may attack the gastrointestinal tract in various ways, one of which is by creating a coagulopathy that may lead to acute ...ischemia of the bowel, increasing morbidity and mortality rates in these patients.
We present a case of a white 72-year-old European male, who was admitted to the intensive care unit after developing COVID-19-induced acute respiratory distress syndrome. On the third week, despite a favorable evolution of his respiratory symptoms, the patient became clinically septic; laboratory findings showed an augmentation of his D-dimer, fibrinogen, C-reactive protein, and procalcitonin levels. Imaging showed signs of ischemia of the right colon. The patient was taken to the operating room; only the right side of his colon was ischemic, with a well demarcated cut-off. A laparoscopic right hemicolectomy with a terminal ileostomy was performed. The patient was able to go home 2 weeks after surgery.
Ischemic colitis is an uncommon pathology in the general population, and is rare in COVID-19 patients. Most cases of ischemic colitis in COVID-19 patients in the literature were limited to the left colon, with < 10 cases involving the right colon. Accurate and quick diagnosis with appropriate management is the key to avoid any mortality in those patients who are already weakened by the coronavirus.
Colorectal cancer (CRC) is the third most diagnosed cancer, and requires surgical resection and reconnection, or anastomosis, of the remaining bowel to re-establish intestinal continuity. Anastomotic ...leak (AL) is a major complication that increases mortality and cancer recurrence. Our objective is to assess the causal role of gut microbiota in anastomotic healing.
The causal role of gut microbiota was assessed in a murine AL model receiving faecal microbiota transplantation (FMT) from patients with CRC collected before surgery and who later developed or not, AL. Anastomotic healing and gut barrier integrity were assessed after surgery. Bacterial candidates implicated in anastomotic healing were identified using 16S rRNA gene sequencing and were isolated from faecal samples to be tested both
and
.
Mice receiving FMT from patients that developed AL displayed poor anastomotic healing. Profiling of gut microbiota of patients and mice after FMT revealed correlations between healing parameters and the relative abundance of
and
. Oral supplementation with
resulted in a higher rate of leaks in mice, while gavage with
improved healing by exerting an anti-inflammatory effect. Patients with AL and mice receiving FMT from AL patients presented upregulation of mucosal MIP-1α, MIP-2, MCP-1 and IL-17A/F before surgery. Retrospective analysis revealed that patients with AL present higher circulating neutrophil and monocyte counts before surgery.
Gut microbiota plays an important role in surgical colonic healing in patients with CRC. The impact of these findings may extend to a vast array of invasive gastrointestinal procedures.
The aim of this study was to evaluate the impact of a preoperative feeding jejunostomy (FJ) on the occurrence of sarcopenia before and after preoperative chemotherapy for patients with an oesogastric ...adenocarcinoma (OGA). Forty-six patients with potentially resectable OGA were enrolled in a perioperative chemotherapy protocol. Sarcopenia was evaluated by measuring muscle surfaces (psoas, paraspinal and abdominal wall muscles) on abdominal CT images at the level of the 3rd lumbar vertebra. A FJ was placed in 31 patients (67.4%) before the neoadjuvant treatment (FJ group), while 15 patients (32.6%) started neoadjuvant treatments without FJ (control group). After preoperative chemotherapy, there were significantly more sarcopenic patients in the control group, compared to the FJ group. In the FJ group, 13% of the patients (n = 4) were sarcopenic before treatment and 22.6% of them (n = 7) became sarcopenic after preoperative chemotherapy (p = 0.3). In the control group, if initially only 6.7% (n = 1) of patients were sarcopenic, the majority of the patients (60%, n = 9) became sarcopenic after chemotherapy (p = 0.012). The FJ was an independent risk factor of sarcopenia after neoadjuvant chemotherapy. FJ with enteral nutritional support during the preoperative management of OGA seemed to efficiently counteract sarcopenia occurrence during preoperative chemotherapy.
Introduction
In Saudi Arabia, the prevalence of obesity has multiplied in the last decades leading to a surge in bariatric surgery and other endoscopic modalities. The intra-gastric balloon (IGB) is ...the most used endoscopic modality. Surgical management for IGB complications is required for gastrointestinal perforation and/or obstruction. However, the literature seems to underestimate these complications.
Materials and Methods
A retrospective descriptive study was conducted in King Fahd University Hospital, Saudi Arabia, from Jan 2017 to Dec 2021, including all patients with complicated IGB who necessitated any surgical procedure. Exclusion criteria were patients with complicated IGBs that were only managed conservatively or endoscopically.
Results
A total of 326 patients were admitted with different complications after bariatric procedures. Of them, six patients were referred due to IGB complications that necessitated operative intervention. All patients were young females. Three patients had gastric wall perforation, and were managed by endoscopic removal of the IGBs followed by exploratory laparotomy. One patient had an intestinal obstruction on top of a migrated IGB that was surgically removed. One patient had failed endoscopic retrieval of IGB and required a laparoscopic gastrostomy. Another patient had an esophageal rupture that required left thoracotomy, pleural flap, and insertion of an esophageal stent. All cases were discharged and followed up with no related complications.
Conclusion
IGB is an endoscopic alternative, within specific indications, for the management of obesity. However, surgical management may be necessary to manage its complications, including gastrointestinal perforation, IGB migration, and failure of endoscopic removal.
Graphical Abstract
Background: Anastomotic leak (AL) is a major complication in colorectal surgery and significantly increases morbidity and mortality. Our objective was to investigate the possible role of the gut ...microbiome in anastomotic healing. Methods: Preoperative fecal samples and intraoperative mucosal samples were collected from a cohort of patients with colorectal cancer (CRC). The gut microbiota of patients with AL and of other patients who presented optimal healing was analyzed and compared using the Anchor 16S rRNA gene amplicon pipeline. Fecal microbiota transplantation (FMT) was performed in mice using fecal samples from patients with and without AL. Transplanted mice underwent colonic surgery. Anastomotic healing and gut barrier integrity were evaluated 6 days later. Additionally, the gut microbiota composition was assessed to detect potential differences. Results: After surgery, mice transplanted with the fecal microbiota of donors with AL displayed poorer macroscopic healing of the anastomosis. They also displayed greater gut permeability, as judged by increased bacterial translocation to the spleen. Lower concentrations of collagen and fibronectin in these mice indicated poor extracellular matrix (ECM) formation at the wound site. A higher concentration of tumour necrosis factor α (TNF-α) was noted in the anastomotic tissue of mice colonized with the microbiota of patients with AL. This was accompanied by higher expression of collagenolytic enzymes involved in ECM degradation. Gut microbiota β-diversity was significantly different between the 2 groups and bacterial species were shown to be associated with the healing process. Conclusion: The gut microbiota in patients with poor postoperative healing induces poor healing in mice. These results suggest that the gut microbiota in patients with CRC may play a role in anastomotic healing after surgery.
