Daniel HERRON

In this key lecture, Dr. Herron looks into the influence of volumes of patients on clinical outcome.

In this key lecture, Dr. Herron outlines the surgical management of RYGB complications.

Sleeve gastrectomy is a valuable emerging bariatric procedure. In this authoritative lecture, Dr. Herron presents the results of this procedure on metabolic aspects.

The video entitled "Robotic-assisted mini gastric bypass", authored by M Vix, KH Liu, and J Marescaux, is analyzed by Dr. Daniel Herron, MD, FACS (Mount Sinai Hospital, New York, United States of America), sharing in this way his own personal experience and highlighting the different surgical approaches available with tips and tricks.

The video entitled "Typical procedure for laparoscopic gastric bypass: gastrojejunostomy with circular stapler", authored by M Vix and J Marescaux, is analyzed by Dr. Daniel Herron, MD (Mount Sinai Hospital, New York, United States), sharing in this way his own personal experience and highlighting the different surgical approaches available with tips and tricks.

Small bowel obstruction at or near the jejuno-jejunal anastomosis is a rare complication after gastric bypass, occurring in less than 1% of patients. Obstruction at the distal anastomosis is different from stricture at the proximal anastomosis, in that it is not caused by hypertrophic scarring. Rather, obstruction occurs due to either abnormal folding (kinking) of the anastomosis or narrowing of the anastomosis at the site of the enterotomy closure due to technical error. Since the distal anastomosis includes both the alimentary and the biliopancreatic limbs of the bypass, obstruction at this location may present with very different symptoms. Obstruction of the alimentary limb will result in nausea and vomiting, while obstruction of the biliopancreatic limb results in gastric remnant dilatation. Diagnosis is best accomplished with CT imaging, as plain X-rays will not show a dilated gastric remnant or biliopancreatic limb. Treatment of obstruction at the jejunojejunostomy often requires surgical intervention, although blockage due to edema may resolve with conservative management, sometimes requiring percutaneous decompression of the excluded stomach. It should also be remembered that bariatric patients may also suffer from obstruction caused by adhesions and may require lysis of such adhesions like any general surgical patient.