LAPAROSCOPIC ILEAL LOOP CONDUIT: AN EXPERIMENTAL STUDY IN DOGS

Objective This experimental study in dogs aimed at establishing a technique for laparoscopic construction of an ileal loop conduit for urinary diversion. Material and Methods Eight mongrel dogs were included in the study. All of them were subjected to preoperative intravenous urography (IVU) for evaluation of the upper urinary tract. In the first four dogs (Group I) ileal loop conduits were constructed via a transperitoneal approach with implantation of the right ureter only to the newly fashioned conduit. Group II consisted of another four dogs in which the conduits were created and both ureters were reanastomosed to their walls. All procedures were done laparoscopically. Postoperatively, all dogs were evaluated using IVU and diuretic renography. The conduits were further evaluated by loopograms. Results Open conversion was not necessary in any animal. The mean operative time was 5 ± 1.5 hours and 4 ± 0.5 hours for Groups I and II, respectively. One dog of Group I died postoperatively because of urinary leakage. Thus, only three units were evaluable. Two of them showed a perfect configuration on IVU film, while a ureteroileal stricture was detected in one. Mean renographic clearance was 55 ± 10.5 ml/minute. Eight renal units could be assessed in Group II. All showed perfect postoperative configurations during radiological assessment with a mean renographic clearance of 56 ± 8 ml/minute. The loopograms showed adequately fashioned conduits in all dogs with no leakage. Conclusion This experimental study confirmed the feasibility of laparoscopic ileal conduit construction with a satisfactory outcome. Although technically challenging, ongoing technical refinements will make the performance of reconstructive laparoscopy more widely acceptable. La Dérivation Cutanée Trans-Intestinale par Voie Laparoscopique: Une Etude Expérimentale chez le Chien Objectif Cette étude expérimentale avait pour but d'établir une technique pour la confection par voie laparoscopique d'une dérivation urinaire trans-intestinale. Matériel et Méthodes Huit chiens de race Mongrel ont été inclus dans cette étude. Tous ont eu une urographie intra-veineuse (UIV) pour l'évaluation de leur haut appareil urinaire. Chez les 4 premiers chiens (Group I) la dérivation a été réalisée par voie trans-péritonéale avec implantation de l'uretère droit seul dans le conduit nouvellement confectionné. Le groupe II comprenait 4 chiens chez lesquels les conduits étaient crées et les deux uretères anastomosés dans la paroi. Toutes les opérations ont été réalisées par voie laparoscopique. En post-opératoire, tous les chiens ont été évalués par UIV et néphrographie aux diurétiques. Les conduits de dérivation ont été évalués par opacification de l'anse de dérivation. Résultats Une conversion en chirurgie ouverte n'a été nécessaire chez aucun animal. La durée moyenne de l'opération était de 5 ± 1.5 heures et 4 ± 0.5 heures pour les groupes I et II respective-ment. Un des chiens du groupe I décéda en post-opératoire du fait de fuites urinaires. Ainsi, seuls trois unités ont été évaluables. Parmi ces dernières deux ont montré une belle configuration à l'UIV tandis que chez un a été retrouvée une sténose urétéro-iléale. La clairance rénale moyenne était de 55 ± 10.5 ml/minute. Huit unités rénales ont pu être évaluées dans le groupe II. Elles ont toutes montré une parfaite configuration post-opératoire à l'évaluation radiographique avec une clairance rénale moyenne de 56 ± 8 ml/minute. Les opacifications du conduit iléal de dérivation ont montré des conduits adéquatement confectionnés sans aucune fuite urinaire. Conclusion Cette étude expérimentale confirme la faisabilité de la confection par voie laparoscopique d'un conduit de dérivation urinaire trans-intestinale avec des suites satisfaisantes. Bien que techniquement exaltante, les affinements techniques en cours vont rendre les performances de la laparoscopie reconstructrice plus largement acceptable. African Journal of Urology Vol.8(3) 2002: 131-13

30-day morbidity and mortality of sleeve gastrectomy, Roux-en-Y gastric bypass and one anastomosis gastric bypass: a propensity score-matched analysis of the GENEVA data

Background: There is a paucity of data comparing 30-day morbidity and mortality of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB). This study aimed to compare the 30-day safety of SG, RYGB, and OAGB in propensity score-matched cohorts. Materials and methods: This analysis utilised data collected from the GENEVA study which was a multicentre observational cohort study of bariatric and metabolic surgery (BMS) in 185 centres across 42 countries between 01/05/2022 and 31/10/2020 during the Coronavirus Disease-2019 (COVID-19) pandemic. 30-day complications were categorised according to the Clavien–Dindo classification. Patients receiving SG, RYGB, or OAGB were propensity-matched according to baseline characteristics and 30-day complications were compared between groups. Results: In total, 6770 patients (SG 3983; OAGB 702; RYGB 2085) were included in this analysis. Prior to matching, RYGB was associated with highest 30-day complication rate (SG 5.8%; OAGB 7.5%; RYGB 8.0% (p = 0.006)). On multivariate regression modelling, Insulin-dependent type 2 diabetes mellitus and hypercholesterolaemia were associated with increased 30-day complications. Being a non-smoker was associated with reduced complication rates. When compared to SG as a reference category, RYGB, but not OAGB, was associated with an increased rate of 30-day complications. A total of 702 pairs of SG and OAGB were propensity score-matched. The complication rate in the SG group was 7.3% (n = 51) as compared to 7.5% (n = 53) in the OAGB group (p = 0.68). Similarly, 2085 pairs of SG and RYGB were propensity score-matched. The complication rate in the SG group was 6.1% (n = 127) as compared to 7.9% (n = 166) in the RYGB group (p = 0.09). And, 702 pairs of OAGB and RYGB were matched. The complication rate in both groups was the same at 7.5 % (n = 53; p = 0.07). Conclusions: This global study found no significant difference in the 30-day morbidity and mortality of SG, RYGB, and OAGB in propensity score-matched cohorts. © 2021, The Author(s)