LGCP is feasible, safe, and effective for at least 18 months when performed on morbidly obese patients. Longer follow-up and prospective comparative trials are needed.

No abstract

Gastrobronchial fistula (GBF) is a serious complication following bariatric surgery, whose treatment by thoracotomy and/or laparotomy involves a high morbidity rate. We present the outcomes of endoscopic management for GBF as a helpful technique for its healing process. This is a multicenter retrospective study of 15 patients who underwent gastric bypass (n = 10) and sleeve gastrectomy (n = 5) and presented GBF postoperatively (mean of 6.7 months). Ten patients developed lung abscess and were treated by antibiotic therapy (n = 10) and thoracotomy (n = 3). Abdominal reoperation was performed in nine patients for abscess drainage (n = 9) and/or ring removal (n = 4) and/or nutritional access (n = 6). The source of the GBF was at the angle of His (n = 14). Furthermore, 14 patients presented a narrowing of the gastric pouch treated by 20 or 30 mm aggressive balloon dilation (n = 11), stricturotomy or septoplasty (n = 10) and/or stent (n = 7). Fibrin glue was used in one patient. We performed, on average, 4.5 endoscopic sessions per patient. Endotherapy led to a 93.3% (14 out of 15) success rate in GBF closure with an average healing time of 4.4 months (range, 1-10 months), being shorter in the stent group (2.5 × 9.5 months). There was no recurrence during the average 27.3-month follow-up. A patient persisted with GBF, despite the fibrin glue application, and decided to discontinue it. GBF is a highly morbid complication, which usually arises late in the postoperative period. Endotherapy through different strategies is a highly effective therapeutic option and should be implemented early in order to shorten leakage healing time.

Migration of the adjustable gastric band (AGB) is a serious complication which usually does not require emergency treatment, except when there is a risk to life. We report a 30-year-old patient who presented with syncope, melena and hypovolemic shock due to the intragastric erosion of an AGB, 13 months after laparoscopic band placement. The diagnosis of migration had been made 7 months after placement, and bleeding only occurred 6 months later. Greater intraluminal penetration had been awaited to facilitate gastroscopic extraction, but, faced with hemodynamic instability, resuscitation was carried out followed by emergency endoscopy to cut the device, using endoscopic scissors. Then, the band was removed orally. There has been no recurrence of hemorrhage 12 months later. Delayed treatment may be indicated in cases of initial band migration; however, rigorous follow-up is necessary with frequent re-evaluation, to diagnose potentially life-threatening complications promptly.

No abstract

We describe the case of early band migration that developed into intraabdominal infection treated by natural orifice translumenal endoscopic surgery. A 40-year-old man was seen 4 years after gastric band placement. He complained of epigastric pain and fever. Gastroscopy revealed minimal gastric fundus erosion and a bulging of the antrum wall. Abdominal CT scan showed perigastric abscess surrounding the band tube. Antibiotic therapy was initiated, and endoscopic transgastric abscess drainage was performed. The endoscope was guided into the abscess cavity, and the band tubing was brought into the gastric lumen to serve as a stent to drain the infection, which ceased 5 days later. During the follow-up, the mucosa covering the band was incised in two more sessions to hasten the erosion process. Endoscopic removal was done 7 months after the drainage.

Use of ring in gastric bypass surgery: Advantages and disadvantages

EP, Siqueira LT, Evangelista LFL, Vasconcelos CS, Ferraz AAB, Ferraz EM. Bypass gástrico laparoscópico com uso reduzido de suturas mecânicas. ABCD Arq Bras Cir Dig. 2008;21(2):73-6 RESUMO -Racional -A execução de bypass gástrico laparoscópico em hospital universitário público tem sido difícil devido ao elevado custo dos grampeadores cirúrgicos que prejudica o treinamento de médicos residentes e tem motivado a busca por técnicas alternativas, de baixo custo, mantendo a eficácia. Objetivo -Apresentar a viabilidade de um método com menor uso de suturas mecânicas. Métodos -Foram operados 63 pacientes em 2 hospitais universitários, sendo 12 homens e 51 mulheres (81%), com média de 33,5 anos de idade e IMC médio de 43. Aplicou-se a seguinte padronização técnica: Secção da alça com bisturi elétrico a 50 cm do ângulo duodeno-jejunal, anastomose término-lateral, passagem da alça retrocólica e retrogástrica, confecção da parede lateral da bolsa gástrica com 1 carga azul de 45 e outra de 60 mm após a secção horizontal com bisturi elétrico, sutura do estômago excluso e anastomose gastrojejunal. As anastomoses foram manuais e contínuas com fio absorvível. Resultados -O tempo operatório médio foi de 5,5 horas. As complicações precoces foram: fístula no ângulo de esôfago-gástrico (1,6%), estenose (1,6%) e fístula na anastomose gastrojejunal (1,6%) e torção da anastomose intestinal (1,6%). A estenose foi tratada por dilatação endoscópica e as outras complicações através de 3 re-operações (2 laparoscópicas e 1 laparotômica). O tempo de internação variou de 2 a 20 dias, com média de 4 dias, não havendo óbito. Conclusão -Este método é viável e com baixo custo operacional; todavia, é complexo e requer habilidade principalmente em suturas laparoscópicas. DESCRITORES -Cirurgia bariátrica. Bypass gástrico laparoscópico. Suturas mecânicas. Custo. ABCD Arq Bras Cir Dig InTRODUçãOO bypass gástrico sem grampeador ou usando menor número de cargas é procedimento que já foi descrito em poucas séries na literatura, e apresenta a vantagem de diminuir custos e complicações associadas ao uso de grampeador, tal como sangramento e fístula. Por outro lado, o tempo cirúrgico é maior, há risco de lesão térmica e a curva de aprendizado é mais longa 1 .Assim, objetiva-se com a proposta deste trabalho apresentar alternativa de método com baixo custo operacional. , com as seguintes co-morbidades: hipertensão arterial sistêmica (9,5%), diabetes mellitus (5,7%), hipotireoidismo (2,5%) e colecistolitíase (1,8%). Os pacientes apresentavam as seguintes operações prévias: colecistectomia (3,8%), cesárea e laqueadura tubária (3,8%), e histerectomia (1,6%). Foram executadas os seguintes procedimentos associados: colecistectomia (4,7%) e gastrostomia (3,2%). MÉTODOSUtilizou-se número reduzido de cargas de grampeador na confecção da bolsa gástrica, que variou de 2 a 4 cargas, enquanto que as anastomoses sempre foram manuais, apesar de algumas terem sido inicialmente confeccionadas látero-lateralmente. Paulatinamente, a experiência propiciou a redução do número de...