Laparoscopic gastric pouch and remnant resection: a novel approach to refractory anastomotic ulcers after Roux-en-Y Gastric Bypass: Case reportReportar como inadecuado




Laparoscopic gastric pouch and remnant resection: a novel approach to refractory anastomotic ulcers after Roux-en-Y Gastric Bypass: Case report - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

BMC Surgery

, 11:33

First Online: 02 December 2011Received: 21 August 2011Accepted: 02 December 2011

Abstract

BackgroundAnastomotic or marginal ulcers occur in 0.6 to 16% of patients after laparoscopic Roux-en-Y-Gastric Bypass. Initial therapy aims at eliminating known risk factors including smoking, Helicobacter pylori infection, use of non-steroidal anti-inflammatory drugs and inhibition of gastric acid secretion. While this approach is successful in 68 to 88% of the cases, up to one third of patients need a subsequent surgical revision. However, marginal ulcers still recur in up to 10% of cases after revisional surgery, thus constituting a serious challenge for bariatric surgeons.

Case presentationWe herein report a case of an insidious marginal ulcer refractory to both medical therapy with high-dosed proton pump inhibitors and sucralfate as well as surgical therapy consisting of the lengthening of a short alimentary limb and later resection of the gastroenterostomy and construction of a new tension-free anastomosis. Only after gastrectomy by laparoscopic en-bloc resection of the gastrojejunostomy, the gastric pouch and resection of the gastric remnant with reconstruction by esophagojejunostomy the patient remained free of symptoms.

ConclusionBy laparoscopic resection of the entire gastric pouch and the gastric remnant the risk to leave a suboptimally vascularised or even ischemic pouch in situ was avoided. The esophagojejunostomy was then created in healthy, good vascularised tissue. In our case this novel approach was effective in the management of a refractory anastomotic ulcer and might represent a rescue option when simple revision of the gastrojejunostomy fails.

KeywordsRoux-en-Y-Gastric Bypass bariatric surgery anastomotic ulcer marginal ulcer obesity Electronic supplementary materialThe online version of this article doi:10.1186-1471-2482-11-33 contains supplementary material, which is available to authorized users.

Download fulltext PDF



Autor: Daniel C Steinemann - Marc Schiesser - Pierre-Alain Clavien - Antonio Nocito

Fuente: https://link.springer.com/article/10.1186/1471-2482-11-33







Documentos relacionados