Leak after LRYGB may be difficult to detect. Evidence of respiratory distress and tachycardia exceeding 120 beats per min may be the most useful clinical indicators of leak after laparoscopic Roux-en-Y gastric bypass.

Early intervention after UGI swallow may lessen morbidity. Routine UGI swallow following LRYGBP does not obviate the importance of close clinical follow-up.

Selective use of flexible nephroscopy after percutaneous nephrostolithotomy based on positive CT findings will avoid an unnecessary operation in 20% of patients. The rate of unnecessary procedures is 32% if all patients undergo flexible nephroscopy, regardless of radiographic findings. At our institution this strategy will result in a cost savings of $109,687 per 100 patients.

No abstract

Background Esophageal perforation, whether spontaneous or more commonly as a result of instrumentation, is a life-threatening condition and carries high mortality despite recent advances. Outcome is dependent on etiology, location of injury, and interval between perforation and initiation of therapy. Successful management of esophageal perforation entails combination of: (1) control of the leakage site either surgically or endoscopically to prevent further contamination, (2) drainage of contamination, and (3) appropriate antibiotics along with nutritional support.Methods We report one case with a 5-cm-long iatrogenic mid-esophageal perforation. The perforation was successfully managed with esophageal tandem stenting above the lower esophageal sphincter (LES). Results The radial expansile force of the inner stent and its anchorage by LES holds the outer stent in place and prevents the tandem stents migrating distally. Conclusions Successful management of esophageal perforation depends on early diagnosis, control of site of leak, drainage of accompanying collections, and antibiotic and nutritional support.