Management of postsurgical leaks in the bariatric patient.

Postsurgical leaks after bariatric procedures are a significant cause of morbidity and mortality. They usually arise from anastomotic and staple line failures that are attributed to surgical technique, ischemia, and patient comorbid conditions. Timely diagnosis from subtle clinical clues is the key to appropriate management.

Laparoscopic repair of perforated marginal ulcer following Roux-en-Y gastric bypass: a case series.

Introduction: Marginal ulcer perforation is a known complication of Roux-en-Y gastric bypass (RYGB), and laparoscopic repair may be a feasible option minimizing the morbidity associated with a large laparotomy incision. We present our experience with laparoscopic repair of perforated marginal ulcers in patients who have previously undergone RYGB.

Methods: A retrospective chart review from August 2005 to April 2007 was performed identifying all patients who underwent laparoscopic repair of perforated marginal ulcer after RYGB at one hospital.

Laparoscopic revisional surgery after Roux-en-Y gastric bypass and sleeve gastrectomy.

Background: Failure of primary bariatric surgery is frequently due to weight recidivism, intractable gastric reflux, gastrojejunal strictures, fistulas, and malnutrition. Of these patients, 10-60% will undergo reoperative bariatric surgery, depending on the primary procedure performed. Open reoperative approaches for revision to Roux-en-Y gastric bypass (RYGB) have traditionally been advocated secondary to the perceived difficulty and safety with laparoscopic techniques.

Transumbilical single-port laparoscopic adjustable gastric band placement with liver suture retractor.

Background: The evolution of single-incision laparoscopic surgery (SILS) has no doubt been impacted by the decrease or elimination of incisions seen with natural orifice transluminal endoscopic surgery (NOTES). SILS upholds the principal advantages of minimal access surgery including shortened hospital stays, the potential for decreased postoperative pain, and cosmetically acceptable scars by reducing large or multiple incisions to a relatively small, single one.

Methods: As opposed to NOTES, SILS does not violate a natural orifice and so the potential for contamination is identical to that of laparoscopy.

Management of anastomotic leaks after Roux-en-Y bypass using self-expanding polyester stents.

Background: To analyze the outcomes of a series of endoscopically placed polyester self-expanding polyflex stents (SEPSs) for the management of anastomotic leaks after Roux-en-Y bypass. Anastomotic leaks after gastric bypass cause significant morbidity and mortality. Covered polyester SEPSs might have a role in the treatment of these leaks.

Use of endoscopic stents to treat anastomotic complications after bariatric surgery.

Background: Complications after bariatric surgery often require longterm parenteral nutrition to achieve healing. Recently, endoscopic treatments have become available that provide healing while allowing for oral nutrition. The purpose of this study was to present outcomes of the largest series to date treating staple line complications after bariatric surgery with endoscopic covered stents.

Hemostasis and hemostatic agents in minimally invasive surgery.

As minimally invasive surgery (MIS) has grown in scope and complexity, new challenges have been introduced along the way, including the need for endoscopic hemostatic techniques. Traditional electrical and mechanical means are still the mainstay, but new technologies for hemostasis continue to emerge. Restricted access to the operative site can limit the use of some tools, and yet multiple chemical hemostats and tamponading agents are used in MIS today.