Transoral rotational esophagogastric fundoplication: technical, anatomical, and safety considerations

Background: Gastroesophageal reflux disease (GERD) results primarily from the loss of an effective antireflux barrier, which forms a mechanical barrier against the retrograde movement of gastric content. Restoration of the incompetent antireflux barrier is possible by longitudinal and rotational advancement of the gastric fundus about the lower esophagus, creating an esophagogastric fundoplication. This article describes the technique of performing a rotational and longitudinal esophagogastric fundoplication, performed transorally using EsophyX. Methods: The transoral incisionless fundoplication (TIF) technique enables the creation of a full-thickness esophagogastric fundoplication with fixation extending longitudinally up to 3.5 cm above the Z-line and rotationally more than 270 degrees around the esophagus. A key element of the technique involves rotating the fundus around the esophagus with a tissue mold during gastric desufflation. Anatomic considerations and use of the device's tissue invaginator to push the esophagus caudally are important to ensure safe positioning of the plications below the diaphragm. The steps of the technique are described in detail, and suggestions are given about patient selection and care, as well as prevention and management of complications. © 2010 The Author(s).SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Antireflux Transoral Incisionless Fundoplication Using EsophyX: 12-Month Results of a Prospective Multicenter Study

BACKGROUND: A novel transoral incisionless fundoplication (TIF) procedure using the EsophyX system with SerosaFuse fasteners was designed to reconstruct a full-thickness valve at the gastroesophageal junction through tailored delivery of multiple fasteners during a single-device insertion. The safety and efficacy of TIF for treating gastroesophageal reflux disease (GERD) were evaluated in a prospective multicenter trial. METHODS: Patients (n = 86) with chronic GERD treated with proton pump inhibitors (PPIs) were enrolled. Exclusion criteria included an irreducible hiatal hernia > 2 cm. RESULTS: The TIF procedure (n = 84) reduced all hiatal hernias (n = 49) and constructed valves measuring 4 cm (2-6 cm) and 230 degrees (160 degrees -300 degrees ). Serious adverse events consisted of two esophageal perforations upon device insertion and one case of postoperative intraluminal bleeding. Other adverse events were mild and transient. At 12 months, aggregate (n = 79) and stratified Hill grade I tight (n = 21) results showed 73% and 86% of patients with >or=50% improvement in GERD health-related quality of life (HRQL) scores, 85% discontinuation of daily PPI use, and 81% complete cessation of PPIs; 37% and 48% normalization of esophageal acid exposure; 60% and 89% hiatal hernia reduction; and 62% and 80% esophagitis reduction, respectively. More than 50% of patients with Hill grade I tight valves had a normalized cardia circumference. Resting pressure of the lower esophageal sphincter (LES) was improved significantly (p < 0.001), by 53%. EsophyX-TIF cured GERD in 56% of patients based on their symptom reduction and PPI discontinuation. CONCLUSION: The 12-month results showed that EsophyX-TIF was safe and effective in improving quality of life and for reducing symptoms, PPI use, hiatal hernia, and esophagitis, as well as increasing the LES resting pressure and normalizing esophageal pH and cardia circumference in chronic GERD patients.Journal ArticleMulticenter StudyResearch Support, Non-U.S. Gov'tinfo:eu-repo/semantics/publishe

Evolution des douleurs lombaires après chirurgie bariatrique.

Although frequently called to mind by physicians, the relationship between overweight and low back pain is poorly understood and remains controversial. The present study aims to evaluate the evolution of low back pain in 65 patients planned for a bariatric surgery. The patients were enrolled prospectively. 54 patients (80%) could be evaluated 5 months after the procedure, and 47 patients (72%) were evaluated 22 months after surgery. Mean weight loss was 19 ± 9 kg (P < 0.001) at 22 months post-op. Patients demonstrated a statistically significant improvement of the NRS, Oswestry and SF-36 scores. This study suggests that low back pain might be reduced following bariatric surgery. However, the lack of dose-response effect is against a causal relationship between low back pain and obesity. Larger randomised controls are needed to determine a causal relationship.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Up-to-down rectal resection with total mesorectal excision through single-incision laparoscopy: video vignette

Conventional laparoscopy of the rectum has shown advantages over laparotomy with equal oncologic results. Single-incision laparoscopy is worthy of consideration during up-to-down rectal resection because it allows single-access at the site of the temporary ileostomy placed at the end of the procedure. This article is protected by copyright. All rights reserved

Implications of Bacteriological Study in Perforated Peptic Ulcer Peritonitis

Background: In the setting of perforated peptic ulcer (PPU) peritonitis, empiric antimicrobial therapy is initiated perioperatively and adapted according to the culture sensitivity. The aim of the study is to describe the microbiota found in the peritonitis due to a PPU, and to evaluate the predictors for bacterial or fungal infection. Material and methods: We performed a single-centre, retrospective observational study of all consecutive patients who presented with PPU peritonitis and underwent emergent surgery in Saint Pierre University Hospital, Brussels, Belgium, between January 2013 and December 2020. The medical history, parameters at admission, bacterial culture, antibiotic resistance and postoperative outcomes were analysed. Results: A total of 43 patients were included in the study. The microbiological culture rate was positive in 31% (13/43) patients. The bacterial culture revealed that the most frequently isolated bacteria were Klebsiella spp. and Enterobacter in 7 % (3/43) of the patients, while the most prevalent fungus isolation was Candida spp. in 16.7 % (7/43) patients. The most prevalent resistances were against ampicillin (17.1 % [7/43]). The Charlson Comorbidity Index was an independent predictor for bacterial infection. Conclusion: Candida spp. Klebsiella spp. and Enterobacter were the most common organisms isolated in the setting of PPU peritonitis.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Long-term outcomes of laparoscopic adjustable gastric banding

Objective: To determine the long-term efficacy and safety of laparoscopic adjustable gastric banding (LAGB) for morbid obesity. Design: Clinical assessment in the surgeon's office in 2009 (≥12 years after LAGB). Setting: University obesity center in Brussels, Belgium. Patients: A total of 151 consecutive patients who had benefited from LAGB between January 1, 1994, and December 31, 1997, were contacted for evaluation. Intervention: Laparoscopic adjustable gastric banding. Main Outcome Measures: Mortality rate, number of major and minor complications, number of corrective operations, number of patients who experienced weight loss, evolution of comorbidities, patient satisfaction, and quality of life were evaluated. Results: The median age of patients was 50 years (range, 28-73 years). The operative mortality rate was zero. Overall, the rate of follow-up was 54.3% (82 of 151 patients). The long-term mortality rate from unrelated causes was 3.7%. Twenty-two percent of patients experienced minor complications, and 39% experienced major complications (28% experienced band erosion). Seventeen percent of patients had their procedure switched to laparoscopic Roux-en-Y gastric bypass. Overall, the (intention-to-treat) mean (SD) excess weight loss was 42.8% (33.92%) (range, 24%-143%). Thirty-six patients (51.4%) still had their band, and their mean excess weight loss was 48% (range, 38%-58%). Overall, the satisfaction index was good for 60.3% of patients. The quality-of-life score (using the Bariatric Analysis and Reporting Outcome System) was neutral. Conclusion: Based on a follow-up of 54.3% of patients, LAGB appears to result in a mean excess weight loss of 42.8% after 12 years or longer. Of 78 patients, 47 (60.3%) were satisfied, and the quality-of-life index was neutral. However, because nearly 1 out of 3 patients experienced band erosion, and nearly 50% of the patients required removal of their bands (contributing to a reoperation rate of 60%), LAGB appears to result in relatively poor long-term outcomes. ©2011 American Medical Association. All rights reserved.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Are laparoscopic gastric bypass after gastroplasty and primary laparoscopic gastric bypass similar in terms of results?

Background: This retrospective study compares the results of primary gastric bypass (PGB) versus secondary gastric bypass (SGB) performed after gastroplasty. Methods: Between January 2004 and August 2008, 576 consecutive patients benefited from laparoscopic gastric bypass (LGB) in our hospital. Four hundred seventy patients (81.6%) were available for full evaluation. Primary outcome measures were operative time, conversion to open surgery and mortality, hospital stay, early and late complications, reoperations, efficacy, and patient satisfaction. Results: Three hundred sixty-two patients benefited from a PGB and 108 from SGB. Median preoperative BMI was 42 kg/m2 (34.8-63.5; PGB) and 39 kg/m2 (20.9-64.5; SGB; p = 0.002). Median operative time was 109 min (40-436; PGB) and 194 min (80-430; SGB; p < 0.001). There was no conversion to open surgery or mortality in either group. Median hospital stay was 4 days (3-95; PGB) and 5 days (2-114; SGB; p < 0.001). Early complications were recorded in 37 patients (10.2%) after PGB and in 24 patients (22.2%) after SGB (p<0.001). Reoperation was necessary in 12 patients (3.3%) after PGB and in 9 patients (8.3%) after SGB (p=0.03). Median follow-up was 35 months (12-66; PGB), and 34 months (12-66; SGB; NS). Late complications were achieved in 46 patients (12.7%) after PGB and in 33 patients (30.6%) after SGB (p<0.001). Reoperation was necessary in 17 patients (4.7%) after PGB and in 11 patients (10.2%) after SGB (p=0.03). Mean %EWL was 74.2% after PGB and 69.9% after SGB (NS). After PGB, 89% of the patients was satisfied, 4% neutral, and 6% unsatisfied; after SGB, 79% was satisfied, 10% neutral, and 11% unsatisfied (p=001). Conclusions: Weight loss after PGB and SGB is not statistically significantly different. Otherwise, operative time, hospital stay, complications, and revision rate are statistically significantly higher after SGB (p < 0.001). © 2010 Springer Science + Business Media, LLC.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Two-year results of a feasibility study on antireflux transoral incisionless fundoplication using EsophyX

SCOPUS: ar.jinfo:eu-repo/semantics/publishe