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A standardized step-by-step description of a laparoscopic Roux-en-Y gastric bypass: a live educational procedure
In this live educational video, Dr. Almino Cardoso Ramos shows the case of a morbidly obese 42-year-old woman with a BMI of 41. In the preoperative work-up, the patient lost 4kg. Imaging studies showed normal anatomy and did not evidence any hiatal hernia or GERD. Manometry did not show any motility disorders.
During the procedure, surgical pitfalls are highlighted and discussed in order to create a standardized Roux-en-Y gastric bypass (RYGB) with a biliopancreatic limb of 150cm and an alimentary limb of 100cm. Anatomical landmarks for gastric pouch creation are demonstrated. Emphasis is put on the adequate length measurement for both the biliopancreatic and alimentary limbs in order to ensure weight loss. The author also stresses the necessity to use appropriate staplers along with the ways to prevent stapler-related complications. He outlines his preference for specific suture material to close the enterotomy, and provides tips and tricks for the closure of the mesenteric defect and of Petersen’s space.
A Cardoso Ramos, M Ignat, R Rodriguez Luna
Surgical intervention
3 months ago
1838 views
16 likes
0 comments
12:49
A standardized step-by-step description of a laparoscopic Roux-en-Y gastric bypass: a live educational procedure
In this live educational video, Dr. Almino Cardoso Ramos shows the case of a morbidly obese 42-year-old woman with a BMI of 41. In the preoperative work-up, the patient lost 4kg. Imaging studies showed normal anatomy and did not evidence any hiatal hernia or GERD. Manometry did not show any motility disorders.
During the procedure, surgical pitfalls are highlighted and discussed in order to create a standardized Roux-en-Y gastric bypass (RYGB) with a biliopancreatic limb of 150cm and an alimentary limb of 100cm. Anatomical landmarks for gastric pouch creation are demonstrated. Emphasis is put on the adequate length measurement for both the biliopancreatic and alimentary limbs in order to ensure weight loss. The author also stresses the necessity to use appropriate staplers along with the ways to prevent stapler-related complications. He outlines his preference for specific suture material to close the enterotomy, and provides tips and tricks for the closure of the mesenteric defect and of Petersen’s space.
Robot-assisted Roux-en-Y gastric bypass using the latest generation of robotic surgical system: a live educational procedure
In this live educational video, Dr. Vieira d'Almeida outlines surgical pitfalls when performing a 5-port Roux-en-Y gastric bypass (RYGB) using the da Vinci Xi™ robotic surgical system (Intuitive Surgical). During the video, a comparison is made with other robotic platforms (e.g. da Vinci Si™ system) regarding trocar placement, robotic docking, dexterity, instruments quality, and the introduction of fluorescence systems. Technical steps are provided to create a RYGB with a 100cm alimentary limb and a 150cm biliary limb, transection of the greater omentum, Petersen’s defect and mesenteric defect closure, which are performed routinely.
LA Vieira d'Almeida, M Ignat, R Rodriguez Luna
Surgical intervention
3 months ago
1006 views
13 likes
0 comments
09:59
Robot-assisted Roux-en-Y gastric bypass using the latest generation of robotic surgical system: a live educational procedure
In this live educational video, Dr. Vieira d'Almeida outlines surgical pitfalls when performing a 5-port Roux-en-Y gastric bypass (RYGB) using the da Vinci Xi™ robotic surgical system (Intuitive Surgical). During the video, a comparison is made with other robotic platforms (e.g. da Vinci Si™ system) regarding trocar placement, robotic docking, dexterity, instruments quality, and the introduction of fluorescence systems. Technical steps are provided to create a RYGB with a 100cm alimentary limb and a 150cm biliary limb, transection of the greater omentum, Petersen’s defect and mesenteric defect closure, which are performed routinely.
Laparoscopic sleeve gastrectomy: surgical pitfalls in a live educational procedure
In this live educational video, Professor Himpens presents the case of a 34-year-old female patient (BMI of 41) with a history of morbid obesity since adolescence. She will undergo a laparoscopic sleeve gastrectomy (LSG). The preoperative work-up was normal. She had lost 2Kg six months before the procedure. Nowadays, laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed bariatric procedures. Surgical pitfalls are emphasized during the video to make sure that LSG is achieved adequately and to prevent any potential complications. In addition, trocars placement, location of the first firing of the linear stapler, the reasons why oversewing of the staple line is not performed, and thrombosis prophylaxis are also discussed during the procedure.
J Himpens, M Ignat, R Rodriguez Luna
Surgical intervention
3 months ago
2304 views
31 likes
1 comment
39:06
Laparoscopic sleeve gastrectomy: surgical pitfalls in a live educational procedure
In this live educational video, Professor Himpens presents the case of a 34-year-old female patient (BMI of 41) with a history of morbid obesity since adolescence. She will undergo a laparoscopic sleeve gastrectomy (LSG). The preoperative work-up was normal. She had lost 2Kg six months before the procedure. Nowadays, laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed bariatric procedures. Surgical pitfalls are emphasized during the video to make sure that LSG is achieved adequately and to prevent any potential complications. In addition, trocars placement, location of the first firing of the linear stapler, the reasons why oversewing of the staple line is not performed, and thrombosis prophylaxis are also discussed during the procedure.
Endoscopic sleeve gastroplasty (ESG): live educational procedure with resolution of device-related complication
Endoscopic sleeve gastroplasty (ESG) is a novel endobariatric procedure with a mechanism of action totally different from the one used for a standard sleeve gastrectomy. An over-the-scope suturing system (OverStitch™, Apollo Endosurgery, Austin, TX) mounted on a dual-channel gastroscope (GIF- 2TH180, Olympus, Center Valley, PA) allowed to place full-thickness sutures in order to obtain gastric volume reduction and shrinking. The number of applied sutures relies on the gastric volume. Sutures are placed starting from the incisura to the fundus that is spared in a U-shaped fashion. A tissue-retracting helix device is used to grab the gastric wall. In this live educational video, Professor Silvana Perretta presented the case of a morbidly obese 38-year-old female patient with a BMI of 36.72kg/m2.
The procedure was performed with the patient under general anesthesia and carbon dioxide insufflation. An Overtube™ (Apollo Endosurgery, Austin, TX) was placed at the beginning of the procedure to protect the airways, the esophagus, and the hypopharynx. Each purse-string suture consisted of 6 to 8 full-thickness bites starting first on the anterior gastric wall, then on the greater curvature, and the posterior wall and moving backward in the opposite direction. Once completed, the suture was tied and knotted using a cinching device (EndoCinch™). During the live procedure, a complication occurred due to an excessive pressure placed on the EndoCinch™ handle which caused a break of the collar part of the cinch. The management of this complication was achieved by cutting the suture, so that the collar part of the cinch which grasped the mucosa could be detached with a grasper to allow for suture replacement. A total of 4 sutures were applied in order to obtain gastric tubulization.
S Perretta, L Guerriero, M Pizzicannella, R Rodriguez Luna, B Dallemagne
Surgical intervention
4 months ago
526 views
7 likes
3 comments
52:53
Endoscopic sleeve gastroplasty (ESG): live educational procedure with resolution of device-related complication
Endoscopic sleeve gastroplasty (ESG) is a novel endobariatric procedure with a mechanism of action totally different from the one used for a standard sleeve gastrectomy. An over-the-scope suturing system (OverStitch™, Apollo Endosurgery, Austin, TX) mounted on a dual-channel gastroscope (GIF- 2TH180, Olympus, Center Valley, PA) allowed to place full-thickness sutures in order to obtain gastric volume reduction and shrinking. The number of applied sutures relies on the gastric volume. Sutures are placed starting from the incisura to the fundus that is spared in a U-shaped fashion. A tissue-retracting helix device is used to grab the gastric wall. In this live educational video, Professor Silvana Perretta presented the case of a morbidly obese 38-year-old female patient with a BMI of 36.72kg/m2.
The procedure was performed with the patient under general anesthesia and carbon dioxide insufflation. An Overtube™ (Apollo Endosurgery, Austin, TX) was placed at the beginning of the procedure to protect the airways, the esophagus, and the hypopharynx. Each purse-string suture consisted of 6 to 8 full-thickness bites starting first on the anterior gastric wall, then on the greater curvature, and the posterior wall and moving backward in the opposite direction. Once completed, the suture was tied and knotted using a cinching device (EndoCinch™). During the live procedure, a complication occurred due to an excessive pressure placed on the EndoCinch™ handle which caused a break of the collar part of the cinch. The management of this complication was achieved by cutting the suture, so that the collar part of the cinch which grasped the mucosa could be detached with a grasper to allow for suture replacement. A total of 4 sutures were applied in order to obtain gastric tubulization.
Wilkie's syndrome surgery
Wilkie’s syndrome (or superior mesenteric artery syndrome) was first described by Von Rokitansky in 1861. It consists in an extrinsic pressure over the third duodenal portion originating from an uncertain cause. Wilkie found a decreased angle (25 degrees, or less) between the superior mesenteric artery and the aorta, conditioning a duodenal (3rd portion) obstruction of vascular origin. It is associated with weight loss. The real incidence remains unknown due to the lack of diagnosis. However, the estimated incidence varies between 0.013 to 1% of the population. The male/female ratio is 2:3, ranging age between 10 and 39 years old.
Symptoms include postprandial abdominal pain, nausea and vomiting, weight loss, early gastric fullness and anorexia (acute high gastroduodenal obstruction).
Diagnostic studies include barium esophageal gastroduodenal series, CT-scan, MRI, high endoscopy (peptic esophagitis, ulcer). Endoscopic studies must come together with barium esophageal gastroduodenal X-ray studies.
Surgical treatment is performed when there is no response to medical treatment, consisting in duodenojejunal anastomoses, with Treitz’s ligament division. Gastrojejunal anastomosis is an alternative option. Laparoscopic surgical treatment can be performed.
G Lozano Dubernard, R Gil-Ortiz Mejía, B Rueda Torres
Surgical intervention
1 year ago
1961 views
10 likes
0 comments
13:16
Wilkie's syndrome surgery
Wilkie’s syndrome (or superior mesenteric artery syndrome) was first described by Von Rokitansky in 1861. It consists in an extrinsic pressure over the third duodenal portion originating from an uncertain cause. Wilkie found a decreased angle (25 degrees, or less) between the superior mesenteric artery and the aorta, conditioning a duodenal (3rd portion) obstruction of vascular origin. It is associated with weight loss. The real incidence remains unknown due to the lack of diagnosis. However, the estimated incidence varies between 0.013 to 1% of the population. The male/female ratio is 2:3, ranging age between 10 and 39 years old.
Symptoms include postprandial abdominal pain, nausea and vomiting, weight loss, early gastric fullness and anorexia (acute high gastroduodenal obstruction).
Diagnostic studies include barium esophageal gastroduodenal series, CT-scan, MRI, high endoscopy (peptic esophagitis, ulcer). Endoscopic studies must come together with barium esophageal gastroduodenal X-ray studies.
Surgical treatment is performed when there is no response to medical treatment, consisting in duodenojejunal anastomoses, with Treitz’s ligament division. Gastrojejunal anastomosis is an alternative option. Laparoscopic surgical treatment can be performed.
Pylorus-preserving laparoscopic gastrectomy with pyloric balloon dilatation
Gastric cancer screening programs implemented by Japan and South Korea have shown impressive results in terms of the increasing proportion of early gastric cancer diagnosis. Because of this, more interest has been focused on preserving the organ function in order to improve postoperative quality of life aiming to reduce complications or sequelae and avoiding large resections. Pylorus-preserving gastrectomy (PPG) was first introduced by Maki et al. and it is probably the most representative technique of function-preserving gastrectomy. It has been reported that, due to an impaired pyloric function, patients may occasionally experience a sensation of gastric fullness after food intake as well as long-term food retention in the remnant stomach. This delayed gastric emptying caused by pyloric spasms has been shown to decrease the patient’s quality of life. There is no standardized management strategy at present, and consequently gastric surgeons have often found themselves hesitant to perform this minimally invasive, function-preserving surgery. Here, we present a PPG case followed by a pyloric spasm, which was successfully treated with balloon dilatation.
F Signorini, HK Yang
Surgical intervention
10 months ago
2473 views
8 likes
1 comment
10:02
Pylorus-preserving laparoscopic gastrectomy with pyloric balloon dilatation
Gastric cancer screening programs implemented by Japan and South Korea have shown impressive results in terms of the increasing proportion of early gastric cancer diagnosis. Because of this, more interest has been focused on preserving the organ function in order to improve postoperative quality of life aiming to reduce complications or sequelae and avoiding large resections. Pylorus-preserving gastrectomy (PPG) was first introduced by Maki et al. and it is probably the most representative technique of function-preserving gastrectomy. It has been reported that, due to an impaired pyloric function, patients may occasionally experience a sensation of gastric fullness after food intake as well as long-term food retention in the remnant stomach. This delayed gastric emptying caused by pyloric spasms has been shown to decrease the patient’s quality of life. There is no standardized management strategy at present, and consequently gastric surgeons have often found themselves hesitant to perform this minimally invasive, function-preserving surgery. Here, we present a PPG case followed by a pyloric spasm, which was successfully treated with balloon dilatation.
Laparoscopic Biliopancreatic Diversion with Duodenal Switch (BPD/DS)
Morbid obesity has reached epidemic proportions. Biliopancreatic diversion with duodenal switch (BPD-DS) is the most effective bariatric surgery procedure for weight loss. This procedure was first described by Scopinaro in 1979. It consisted of a horizontal gastrectomy, a transection of the bowel halfway from the ligament of Treitz and the ileocecal junction, and a Roux-en-Y reconstruction with a 50cm common channel. This was later modified: the duodenal switch was added and the gastrectomy was performed in a vertical sleeve fashion, thereby preserving the pylorus and increasing the common channel to 100cm. This modification greatly reduced the incidence of marginal ulceration, dumping, and nutritional deficiencies. However, this operation is still uncommon due to the perceived technical difficulty and risk of nutritional morbidity. This video demonstrates a standardized technique for this complex procedure.
RC Pullatt
Surgical intervention
10 months ago
4568 views
18 likes
4 comments
13:00
Laparoscopic Biliopancreatic Diversion with Duodenal Switch (BPD/DS)
Morbid obesity has reached epidemic proportions. Biliopancreatic diversion with duodenal switch (BPD-DS) is the most effective bariatric surgery procedure for weight loss. This procedure was first described by Scopinaro in 1979. It consisted of a horizontal gastrectomy, a transection of the bowel halfway from the ligament of Treitz and the ileocecal junction, and a Roux-en-Y reconstruction with a 50cm common channel. This was later modified: the duodenal switch was added and the gastrectomy was performed in a vertical sleeve fashion, thereby preserving the pylorus and increasing the common channel to 100cm. This modification greatly reduced the incidence of marginal ulceration, dumping, and nutritional deficiencies. However, this operation is still uncommon due to the perceived technical difficulty and risk of nutritional morbidity. This video demonstrates a standardized technique for this complex procedure.
Laparoscopic gastrectomy for gastric cancer after liver transplantation
It has already been demonstrated that laparoscopic gastrectomy is a safe approach for early gastric cancer. It can provide the same oncological outcomes as open gastrectomy with the benefit of fewer complications and early recovery.
Liver transplantation has a high incidence rate in the Korean population, just like gastric cancer. Additionally, South Korea has the highest incidence of this type of cancer worldwide. Patients who had received a liver transplant might benefit from a better recovery thanks to laparoscopic gastrectomy, and this approach can be performed by experienced surgeons.
Please add in the text narrative how you performed the anastomosis.
F Signorini, DJ Park, HK Yang
Surgical intervention
6 months ago
1597 views
9 likes
0 comments
09:23
Laparoscopic gastrectomy for gastric cancer after liver transplantation
It has already been demonstrated that laparoscopic gastrectomy is a safe approach for early gastric cancer. It can provide the same oncological outcomes as open gastrectomy with the benefit of fewer complications and early recovery.
Liver transplantation has a high incidence rate in the Korean population, just like gastric cancer. Additionally, South Korea has the highest incidence of this type of cancer worldwide. Patients who had received a liver transplant might benefit from a better recovery thanks to laparoscopic gastrectomy, and this approach can be performed by experienced surgeons.
Please add in the text narrative how you performed the anastomosis.
Leiomyosarcoma paracaval laparoscopic resection
Primary retroperitoneal tumors are rare, usually malignant and of mesenchymal origin. Surgery is the treatment of choice and complete tumor excision is the main factor which determines the prognosis. They represent between 0.3 and 0.8% of all neoplasms.
The most frequent tumors are sarcomas in their different varieties (totaling 83.7%), mainly liposarcomas (6-20%) and leiomyosarcomas (8-10%); 85% of retroperitoneal tumors are malignant and, of these, about 50% are sarcomas.
The involvement of the inferior vena cava in different tumor processes has long represented a criterion of inoperability and unresectability.
Extirpative surgery of the entire lesion is the treatment of choice for retroperitoneal tumors, but it is not always possible due to the infiltrative commitment of vital structures, despite the possibility of large visceral resections (stomach, kidney, spleen, tail of the pancreas, duodenum, colon, abdominal cava, etc.) and in which case we will not talk about recurrence but about residual tumor.
The laparoscopic approach performed by a multidisciplinary team with experience and expertise can help establish a correct diagnosis and achieve a fine dissection of the lesion, even if it is in difficult anatomical regions.
The video shows a laparoscopic resection of a paracaval mass of unknown origin. This is the case of a 39-year-old female patient who presents with abdominal pain in the epigastrium and right hypochondrium with 2 weeks of evolution. She receives analgesic treatment without any improvement accompanied by vomiting of gastrobiliary content, exacerbation of pain (VAS of 9/10). Hematic biometrics and blood chemistry demonstrated normal results. Ultrasound, CT-scan of the abdomen, and magnetic resonance cholangiography showed a pericaval tumor of about 6 or 4cm, not compromising the inferior vena cava with intimate interphase. After an appropriate assessment by the multidisciplinary team, it is decided to perform a laparoscopic resection.
Operating time was 110 minutes with insignificant blood loss. The procedure is performed successfully without any complications. There were no intraoperative complications. Oral feeding was reintroduced on the first postoperative day and the patient was discharged on postoperative day 2, without complications. Histopathological examination revealed a low-grade leiomyosarcoma. 5 years of follow-up without adjacent lesions.
JL Limon Aguilar, CO Castillo Cabrera
Surgical intervention
6 months ago
767 views
10 likes
0 comments
12:31
Leiomyosarcoma paracaval laparoscopic resection
Primary retroperitoneal tumors are rare, usually malignant and of mesenchymal origin. Surgery is the treatment of choice and complete tumor excision is the main factor which determines the prognosis. They represent between 0.3 and 0.8% of all neoplasms.
The most frequent tumors are sarcomas in their different varieties (totaling 83.7%), mainly liposarcomas (6-20%) and leiomyosarcomas (8-10%); 85% of retroperitoneal tumors are malignant and, of these, about 50% are sarcomas.
The involvement of the inferior vena cava in different tumor processes has long represented a criterion of inoperability and unresectability.
Extirpative surgery of the entire lesion is the treatment of choice for retroperitoneal tumors, but it is not always possible due to the infiltrative commitment of vital structures, despite the possibility of large visceral resections (stomach, kidney, spleen, tail of the pancreas, duodenum, colon, abdominal cava, etc.) and in which case we will not talk about recurrence but about residual tumor.
The laparoscopic approach performed by a multidisciplinary team with experience and expertise can help establish a correct diagnosis and achieve a fine dissection of the lesion, even if it is in difficult anatomical regions.
The video shows a laparoscopic resection of a paracaval mass of unknown origin. This is the case of a 39-year-old female patient who presents with abdominal pain in the epigastrium and right hypochondrium with 2 weeks of evolution. She receives analgesic treatment without any improvement accompanied by vomiting of gastrobiliary content, exacerbation of pain (VAS of 9/10). Hematic biometrics and blood chemistry demonstrated normal results. Ultrasound, CT-scan of the abdomen, and magnetic resonance cholangiography showed a pericaval tumor of about 6 or 4cm, not compromising the inferior vena cava with intimate interphase. After an appropriate assessment by the multidisciplinary team, it is decided to perform a laparoscopic resection.
Operating time was 110 minutes with insignificant blood loss. The procedure is performed successfully without any complications. There were no intraoperative complications. Oral feeding was reintroduced on the first postoperative day and the patient was discharged on postoperative day 2, without complications. Histopathological examination revealed a low-grade leiomyosarcoma. 5 years of follow-up without adjacent lesions.
Laparoscopic total gastrectomy
A multimodality approach remains the only potential treatment for advanced gastric cancer. Oncological outcomes seem to be equivalent either in open surgery or in minimally invasive surgery. Therefore, laparoscopic gastric resection is expanding in expert centers.
The authors present a clinical case of a 70-year-old woman with no relevant clinical past. She presented with a 1-month complaint of epigastric pain and melena. She underwent an upper endoscopy, which showed an ulcerated gastric lesion at the lesser curvature. Biopsy revealed a poorly cohesive gastric carcinoma with signet ring cells. Thoraco-abdominal-pelvic CT-scan revealed a thickening of the gastric wall associated with multiple perigastric and celiac trunk lymph nodes. She was proposed for perioperative chemotherapy. On the restaging CT-scan, there was no evidence of disease progression and therefore she underwent a laparoscopic radical total gastrectomy.
The benefits of minimally invasive surgery, combined with the increasing evidence of oncological results overlapping with open surgery, have contributed to the progressive implementation of laparoscopic surgery in the treatment of malignant gastric pathology.
J Magalhães, C Osorio, L Frutuoso, AM Pereira, A Trovão, R Ferreira de Almeida, M Nora
Surgical intervention
1 year ago
6859 views
30 likes
1 comment
09:44
Laparoscopic total gastrectomy
A multimodality approach remains the only potential treatment for advanced gastric cancer. Oncological outcomes seem to be equivalent either in open surgery or in minimally invasive surgery. Therefore, laparoscopic gastric resection is expanding in expert centers.
The authors present a clinical case of a 70-year-old woman with no relevant clinical past. She presented with a 1-month complaint of epigastric pain and melena. She underwent an upper endoscopy, which showed an ulcerated gastric lesion at the lesser curvature. Biopsy revealed a poorly cohesive gastric carcinoma with signet ring cells. Thoraco-abdominal-pelvic CT-scan revealed a thickening of the gastric wall associated with multiple perigastric and celiac trunk lymph nodes. She was proposed for perioperative chemotherapy. On the restaging CT-scan, there was no evidence of disease progression and therefore she underwent a laparoscopic radical total gastrectomy.
The benefits of minimally invasive surgery, combined with the increasing evidence of oncological results overlapping with open surgery, have contributed to the progressive implementation of laparoscopic surgery in the treatment of malignant gastric pathology.
A young lady with dysphagia and GIST after a complicated sleeve gastrectomy for morbid obesity
A 34 year-old woman was referred to us for persistent dysphagia and retrosternal chest pain, aggravated by eating. Two years earlier, she underwent a laparoscopic sleeve gastrectomy for morbid obesity.
Her operation was complicated by septic shock due to an esophagogastric fistula with subphrenic abscesses, and on postoperative day 20, she underwent a laparotomy, abscess debridement and drainage, splenectomy and application of cyanoacrylate-based glue, followed by endoscopic positioning of a self-expandable partially coated prosthesis.
Three weeks afterwards, her prosthesis was replaced with a self-expandable fully coated prosthesis due to persistent leak. This prosthesis was finally removed after 7 weeks.
One year after her operation, at gastroscopy, a 25mm submucosal nodule covered with an ulcerated mucosa was found in the proximal antrum. Biopsy was negative, and endoscopic ultrasonography was suggestive of GIST.
She underwent an esophageal manometry, which was indicative of esophagogastric junction outflow obstruction. Her barium swallow test showed a delayed esophageal emptying due to the narrowing and twisting of the proximal part of the stomach. Her abdominal MRI was normal.
An exploratory laparoscopy was indicated for adhesiolysis and removal of the antral lesion.
Total duration of the operation was 3 hours. Her postoperative course was uneventful and she was discharged on postoperative day 6.
Her postoperative swallow study showed the easy passage of the contrast agent with no leaks. The patient completely recovered from her symptoms, and remained asymptomatic after 30 months. Final histology of her lesion evidenced a foreign body granuloma.
S Greco, M Giulii Capponi, M Lotti, M Khotcholava
Surgical intervention
10 months ago
1799 views
4 likes
2 comments
14:14
A young lady with dysphagia and GIST after a complicated sleeve gastrectomy for morbid obesity
A 34 year-old woman was referred to us for persistent dysphagia and retrosternal chest pain, aggravated by eating. Two years earlier, she underwent a laparoscopic sleeve gastrectomy for morbid obesity.
Her operation was complicated by septic shock due to an esophagogastric fistula with subphrenic abscesses, and on postoperative day 20, she underwent a laparotomy, abscess debridement and drainage, splenectomy and application of cyanoacrylate-based glue, followed by endoscopic positioning of a self-expandable partially coated prosthesis.
Three weeks afterwards, her prosthesis was replaced with a self-expandable fully coated prosthesis due to persistent leak. This prosthesis was finally removed after 7 weeks.
One year after her operation, at gastroscopy, a 25mm submucosal nodule covered with an ulcerated mucosa was found in the proximal antrum. Biopsy was negative, and endoscopic ultrasonography was suggestive of GIST.
She underwent an esophageal manometry, which was indicative of esophagogastric junction outflow obstruction. Her barium swallow test showed a delayed esophageal emptying due to the narrowing and twisting of the proximal part of the stomach. Her abdominal MRI was normal.
An exploratory laparoscopy was indicated for adhesiolysis and removal of the antral lesion.
Total duration of the operation was 3 hours. Her postoperative course was uneventful and she was discharged on postoperative day 6.
Her postoperative swallow study showed the easy passage of the contrast agent with no leaks. The patient completely recovered from her symptoms, and remained asymptomatic after 30 months. Final histology of her lesion evidenced a foreign body granuloma.
Proximal gastrectomy with stapled circular esophagogastrostomy: manual purse-string technique
Early tumors of the esophagogastric junction can be managed with a minimally invasive proximal gastrectomy. This operation has recently been reevaluated for early-stage tumors since it offers a good postoperative quality of life with oncological outcomes equivalent to more extended procedures. In this video, we present the case of a 72-year-old man presenting with a 2cm adenocarcinoma of the esophagogastric junction. The clinical stage of the lesion was T1N0. A laparoscopic proximal gastrectomy with stapled circular esophagogastrostomy was decided upon. Five ports were placed. The left trocar incision was enlarged to introduce the circular stapler for the anastomoses and for specimen extraction. The procedure began with a complete abdominal exploration to rule out peritoneal metastases. The gastrocolic and gastrosplenic ligaments were divided with an ultrasonic scalpel. Short splenic vessels were clipped and divided and the greater curvature completely isolated with careful preservation of the gastroepiploic arcade and of the right gastroepiploic artery and vein. Left gastric vessels were divided at their origin with a vascular stapler and the distal esophagus was isolated through the diaphragmatic hiatus. A gastric tube was created with multiple applications of a linear stapler. The anvil of the circular stapler was secured to the esophageal stump with a hand-sewn purse-string suture in order to avoid the overlap of two suture lines. The esophagogastric anastomosis was then achieved with a circular stapler.
C Battiston, D Citterio, L Conti, M Virdis, V Mazzaferro
Surgical intervention
6 months ago
1049 views
19 likes
3 comments
11:43
Proximal gastrectomy with stapled circular esophagogastrostomy: manual purse-string technique
Early tumors of the esophagogastric junction can be managed with a minimally invasive proximal gastrectomy. This operation has recently been reevaluated for early-stage tumors since it offers a good postoperative quality of life with oncological outcomes equivalent to more extended procedures. In this video, we present the case of a 72-year-old man presenting with a 2cm adenocarcinoma of the esophagogastric junction. The clinical stage of the lesion was T1N0. A laparoscopic proximal gastrectomy with stapled circular esophagogastrostomy was decided upon. Five ports were placed. The left trocar incision was enlarged to introduce the circular stapler for the anastomoses and for specimen extraction. The procedure began with a complete abdominal exploration to rule out peritoneal metastases. The gastrocolic and gastrosplenic ligaments were divided with an ultrasonic scalpel. Short splenic vessels were clipped and divided and the greater curvature completely isolated with careful preservation of the gastroepiploic arcade and of the right gastroepiploic artery and vein. Left gastric vessels were divided at their origin with a vascular stapler and the distal esophagus was isolated through the diaphragmatic hiatus. A gastric tube was created with multiple applications of a linear stapler. The anvil of the circular stapler was secured to the esophageal stump with a hand-sewn purse-string suture in order to avoid the overlap of two suture lines. The esophagogastric anastomosis was then achieved with a circular stapler.
Laparoscopic distal gastrectomy with Roux-en-Y reconstruction for a prepyloric lesion: a live educational procedure
This is the case of a 70-year-old patient who underwent an esophagogastroduodenoscopy for gastric pain. The exam showed a 0.5cm prepyloric ulcerated lesion with Helicobacter pylori infection. After Helicobacter pylori eradication and a CT-scan negative for secondary lesions, the patient was scheduled for a distal gastrectomy with perioperative gastroscopy.
In this original live educational video, Dr. Woo Jin Hyung describes his technique of laparoscopic distal gastrectomy with Roux-en-Y reconstruction and discusses several topics such as the comparison between laparoscopic and robotic gastrectomy, the indication for omentectomy, the choice of the surgical strategy considering the tumor location, the benefit of fluorescence in lymphatic mapping, the type of lymphadenectomy, the comparison of different energy devices and the choice of the reconstruction technique.
WJ Hyung, S Perretta, A Spota, D Mutter, J Marescaux
Surgical intervention
6 months ago
3165 views
43 likes
0 comments
57:00
Laparoscopic distal gastrectomy with Roux-en-Y reconstruction for a prepyloric lesion: a live educational procedure
This is the case of a 70-year-old patient who underwent an esophagogastroduodenoscopy for gastric pain. The exam showed a 0.5cm prepyloric ulcerated lesion with Helicobacter pylori infection. After Helicobacter pylori eradication and a CT-scan negative for secondary lesions, the patient was scheduled for a distal gastrectomy with perioperative gastroscopy.
In this original live educational video, Dr. Woo Jin Hyung describes his technique of laparoscopic distal gastrectomy with Roux-en-Y reconstruction and discusses several topics such as the comparison between laparoscopic and robotic gastrectomy, the indication for omentectomy, the choice of the surgical strategy considering the tumor location, the benefit of fluorescence in lymphatic mapping, the type of lymphadenectomy, the comparison of different energy devices and the choice of the reconstruction technique.
Metabolic/bariatric surgery for type 2 diabetes
In this authoritative lecture, Dr. Buchwald focuses on metabolic and bariatric surgery for type 2 diabetes.
Through a valuable account of the historical evolution of the concept of metabolic surgery, Dr. Henry Buchwald, Professor of surgery and biomedical engineering as well as Owen and Sarah Davidson Wangensteen Chair in Experimental Surgery Emeritus at the University of Minnesota shows us the important role that different surgical procedures, both bariatric and non-bariatric, have played in the treatment of diverse metabolic pathologies, especially in the treatment of type 2 diabetes mellitus, emphasizing the rich and intense research activity which has generated this progress and the future of surgery in the treatment of chronic metabolic diseases.
H Buchwald
Lecture
7 months ago
305 views
2 likes
0 comments
23:01
Metabolic/bariatric surgery for type 2 diabetes
In this authoritative lecture, Dr. Buchwald focuses on metabolic and bariatric surgery for type 2 diabetes.
Through a valuable account of the historical evolution of the concept of metabolic surgery, Dr. Henry Buchwald, Professor of surgery and biomedical engineering as well as Owen and Sarah Davidson Wangensteen Chair in Experimental Surgery Emeritus at the University of Minnesota shows us the important role that different surgical procedures, both bariatric and non-bariatric, have played in the treatment of diverse metabolic pathologies, especially in the treatment of type 2 diabetes mellitus, emphasizing the rich and intense research activity which has generated this progress and the future of surgery in the treatment of chronic metabolic diseases.