Laparoscopic Roux-en-Y gastric bypass (RYGB) is currently the preferred surgical procedure to treat morbid obesity. It has proven its effects on excess weight loss and its positive effect on comorbidities. One of the main issues, however, is the post-operative evaluation of the bypassed gastric remnant. In literature, cancer of the excluded stomach after RYGB is rare. We describe the case of a 52-year-old woman with gastric linitis plastica in the bypassed stomach after Roux-en-Y gastric bypass, diagnosed by means of laparoscopy and Single-Balloon enteroscopy, and it is clinical importance. Linitis plastica of the excluded stomach after RYGB is a very rare entity. This case report shows the importance of long-term post-operative follow-up, and the importance of single-balloon enteroscopy for visualization of the bypassed stomach remnant, when other investigations remain without results. This case report is only the second report of a linitis plastica in the bypassed stomach after Roux-en-Y gastric bypass.
Dear Sir, We have read with great interest the case report written by Patrascu et al. (J Minim Access Surg. 2018 Jan-Mar; 14(1):68-70) titled ‘A delayed acute complication of bariatric surgery: Gastric remnant haemorrhagic ulcer after Roux-en-Y gastric bypass’. In the discussion, Patrascu et al. stated that ‘the use of enteroscopy is quite cumbersome for diagnostic and therapeutic interventions’. We agree that an acute haemorrhage with tendency for hypovolemic shock always warrants acute intervention, like in this case urgent laparotomy with control of the bleeding. However, maybe the point of discussion should be why the patient did not undergo endoscopic examination of the remnant stomach before, since there was a history of intermittent upper gastrointestinal bleeding.[1] Pathology of the excluded stomach after Roux-en-Y gastric bypass (RYGB) is underestimated and especially malignancies pose a great treat since access to the remnant stomach is not always easily achieved. Furthermore, symptomatology of this remnant stomach pathology might not always be obvious. We would like to raise awareness about this specific issue as precious time might be lost in waiting for more ‘obvious symptomatology’ like in this case, hypovolemic shock. Our point is to highlight this specific diagnostic limitation after RYGB and show the importance of long-term postoperative follow-up, including low threshold for endoscopic examination of the remnant stomach especially in the case of obvious symptomatology, like intermittent intraluminal bleeding. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Background: An internal abdominal hernia is defined as the protrusion of a viscus through a mesenteric or peritoneal aperture within the peritoneal cavity. A less common type of internal herniation is a small bowel herniation through a defect in the falciform ligament of the liver. This defect can be congenital or iatrogenic after penetration of the falciform ligament with a trocar during laparoscopic surgery.Methods: We present a case report illustrating an internal herniation through an iatrogenic defect in the falciform ligament of the liver.Results: A 78-year-old man comes to the emergency department with severe abdominal pain for several hours. Laparoscopic exploration shows a small bowel herniation through an iatrogenic defect of the falciform ligament after laparoscopic cholecystectomy. Reduction of the internal herniation is performed. Due to subsequently small bowel necrosis, a small bowel resection with primary anastomosis has to be performed too.Conclusion: Small bowel herniation through an iatrogenic defect in the falciform ligament is very rare. However, it can lead to severe complications such as small bowel necrosis. To prevent internal herniation, we strongly suggest immediate repair or division of the falciform ligament when an iatrogenic defect is created during laparoscopic procedures.
Objective: We would like to present a patient with a history of ulcerative colitis suffering from a synchronous rectal and prostate cancer treated with a laparoscopic total proctocolectomy (with TaTME) and Retzius sparing RARP simultaneously.Methods: Retzius sparing RARP with bilateral lymph node harvesting was performed first. Afterwards, TaTME was commenced with the placement of a Lonestar® retractor and GelPort®. Anterior dissection was troubled unexpectedly by outspoken fibrosis. For that reason, it was completed laparoscopically. We then continued with the laparoscopic total proctocolectomy. Last, a transanal circular stapled ileoanal anastomosis was created and a derivating ileostomy was installed.Results: Postoperative proctoscopy showed a patent ileoanal anastomosis. After removal of the Foley catheter on day 21, the patient was immediately continent. Prostate specimen revealed a pT2cN1M0 transmural invasive adenocarcinoma with a Gleason score of 7 (3 + 4). Pathology analysis of the rectum revealed a stage IIIc transmural invasive moderately differentiated rectal adenocarcinoma (pT3N2bM0) with free margins. He was referred for adjuvant chemotherapy.Conclusions: In this case, the combination of TaTME and Retzius sparing RARP for synchronous rectal and prostate cancer was feasible and safe. We suggest performing the anterior TaTME dissection last, due to disturbing blood flow into the operating field after prostatectomy.
Background : The Lichtenstein repair is a well standardized surgical technique that can mostly be performed in day-clinic under loco-regional anesthesia. The major concern is the chronic pain reported after mesh suture fixation. We studied the practical and clinical aspects of a Lichtenstein repair using the semi-resorbable self-fixating Parietex ProGrip™ mesh.Methods : Consecutive patients with inguinal hernia were operated according to the Lichtenstein technique using Parietex ProGrip™.Complications were assessed. Pain and discomfort were evaluated at discharge, and at 1 and 4 weeks and minimum 6 months after the intervention.Results : 320 patients were included in the study. No intra-operative complications or difficulties occurred. Mean operating time was 36 minutes (range 20–65 minutes). 87.5% of the patients (280) were discharged at day of operation, 11.9% (38 patients) had an overnight stay and 0.6% (2 patients) stayed two nights. Mean number of days of analgesic use is 2.1. At the 1 week follow-up visit, minor pain or discomfort was reported by 45 patients (14%) and at 4 weeks 11 patients (3.4%) still had minor discomfort. At 6 months 1 patient suffered from persisting local numbness. Two recurrences were noted, both were re-operated.Conclusions : This observational study confirms earlier findings with this semi-resorbable self-gripping mesh regarding operation time, complications and recurrence. The open Lichtenstein hernia repair with the semi-resorbable self-gripping Parietex Progrip™ mesh seems to offer a reliable alternative for the treatment of inguinal hernia with benefits on operating time as well as on postoperative pain.
