Laparoscopic sleeve gastrectomy with second-stage Roux-en-Y gastric bypass are feasible and effective procedures based on short-term results. This two-stage approach is a reasonable alternative for surgical treatment of the high-risk supersuper obese patient.

Small bowel obstruction from internal hernia following laparoscopic donor nephrectomy is a rare event, but it can lead to significant morbidity in an otherwise healthy patient. These patients may be at higher risk for bowel obstruction given the soft tissue defect remaining after nephrectomy. Vigilance is required when mobilizing the colon to ensure that mesenteric defects are recognized and repaired.

Laparoscopic management of enteric fistula disease is safe and effective. Low morbidity and short hospital stay demonstrate the safety and benefit of the minimally invasive approach for even complicated fistula disease in patients with history of prior abdominal surgery and multiple fistulas, or in patients requiring multiple resections for fistulas from diverticular and Crohn's disease.

Opitz syndrome is a rare genetic disorder which has been well defined; however, the surgical treatment of the anomalies has not been codified. The objective is to review the literature and describe the surgical priorities in the treatment of Opitz syndrome. This report is unique in the fact that it describes a surgical approach to the treatment of the deformities. Better outcomes are achieved with preoperative analysis of the deformities and surgical planning. Simultaneous soft tissues and bony reconstruction with grafts can achieve long lasting results and decrease recurrence rates.

Splenic rupture is a rare but serious complication from cocaine abuse. Given the ubiquitous prevalence of abuse and the potential for death from intraperitoneal bleeding, the prompt diagnosis and treatment of cocaine-induced disease including splenic rupture is essential. The management for splenic rupture from traumatic and atraumatic etiology has shifted from emergent laparotomy and splenectomy to non-operative approach with transcatheter splenic artery embolization. We report a 39-year-old male with a significant substance abuse history who presented with atraumatic splenic rupture. He was managed nonoperatively with adjunctive transcatheter splenic artery embolization. His post-procedure course was complicated by an intra-abdominal abscess requiring drainage via interventional radiology guided pigtail catheter placement and intravenous antibiotics. This case report is intended to raise awareness of the potentiating effects of cocaine use in this patient population and highlight questions raised during this patient's management.