Laparoscopic Management of Gastric Band Migration with Acute Gastric Perforation - a Video Vignette

Laparoscopic adjustable gastric banding (LAGB) was once considered to be a safe and effective surgical treatment for morbid obesity. Over the past years, its long-term efficacy and safety came into question by the occurrence of complications such as intragastric band migration. The incidence of intragastric band migration is reported to be between 0.4 and 3.8% [1,2,3,4]. The incidence of gastric perforations is 0.1–0.8% [5,6,7]. Removal of the band in case of migration is always required and often possible via upper endoscopy [2]. Overall, septic complications are rare. However, when they do occur they can be life-threatening

Salvage Surgery for Severe Post-Bariatric Hypoglycemia After Multiple Bariatric Revisions: Reversing Roux-en-Y Gastric Bypass to Sleeve with Roux Limb as Henley-Longmire Interposition

Despite excellent weight loss and resolution of comorbidities experienced by most patients, Roux-en-Y gastric bypass (RYGB) is known to cause long-term complications that may necessitate revisional intervention or surgery. Post-bariatric hypoglycemia (PBH) is an increasingly recognized RYGB complication afecting 0.1–34% of patients [1–3], which can impact their quality of life [4]. In rare cases, reversing RYGB and restoring normal food passage may be considered due to severe PBH that is refractory to extensive therapeutic interventions [1, 5, 6]. However, reversal procedures carry a high risk of complications and usually require long operative times [7–10]

Evaluation of Electrochemotherapy with Bleomycin in the Treatment of Colorectal Hepatic Metastases in a Rat Model

Background: The available ablative procedures for the treatment of hepatic cancer have contraindications due to the heat-sink effect and the risk of thermal injuries. Electrochemotherapy (ECT) as a nonthermal approach may be utilized for the treatment of tumors adjacent to high-risk regions. We evaluated the effectiveness of ECT in a rat model. Methods: WAG/Rij rats were randomized to four groups and underwent ECT, reversible electroporation (rEP), or intravenous injection of bleomycin (BLM) eight days after subcapsular hepatic tumor implantation. The fourth group served as Sham. Tumor volume and oxygenation were measured before and five days after the treatment using ultrasound and photoacoustic imaging; thereafter, liver and tumor tissue were additionally analysed by histology and immunohistochemistry. Results: The ECT group showed a stronger reduction in tumor oxygenation compared to the rEP and BLM groups; moreover, ECTtreated tumors exhibited the lowest levels of hemoglobin concentration compared to the other groups. Histological analyses further revealed a significantly increased tumor necrosis of >85% and a reduced tumor vascularization in the ECT group compared to the rEP, BLM, and Sham groups. Conclusion: ECT is an effective approach for the treatment of hepatic tumors with necrosis rates >85% five days following treatment

Evaluation of hepatocyte transplantation after surgical induced acute liver failure in a rat model

Titelblatt und Inhaltsverzeichnis Einleitung Material und Methoden Ergebnisse Diskussion LiteraturverzeichnisHINTERGRUND: Als Basis zukünftiger Studien evaluierten wir die Wirksamkeit der Hepatozytentransplantation in einem chirurgischen Modell. METHODE: Im Überlebensmodell der Wistarratte wurde durch eine subtotale Leberteilresektion ein akutes Leberversagen induziert. In verschiedenen Versuchsreihen wurde eine allogene Hepatozytentransplantation durchgeführt, indem Implantationsort, -zeitpunkt und Zellzahl variiert wurden. ERGEBNISSE: Nach einzeitiger subperitonealer oder lienaler Zellimplantation konnte im Vergleich zu den Kontrollgruppen keine Verbesserung des Überlebens erreicht werden. Jedoch wurde nach Implantation von 24 Millionen Hepatozyten in die Milz einen Tag vor der Resektion eine deutliche Steigerung des Überlebens erzielt (von 29% auf 72%). SCHLUSSFOLGERUNG: Hiermit wurde ein Modell etabliert, mit dem durch geeignete Modifikation neue Zellquellen oder neue Konservierungsmethoden in vivo evaluiert werden können, um sie langfristig auf einen klinischen Einsatz vorzubereiten.BACKGROUND: As fundament for future clinical questions, we evaluated the efficacy of hepatocyte transplantation (HcTx) in a surgical model. METHODS: In rats acute liver failure was induced by subtotal hepatectomy. Series of allogenic HcTx were performed by varying cell number, site, and sequence of cell transplantation. RESULTS: Following subperitoneal or intraspleenal cell implantation subsequently to liver surgery, no survival benefit was archieved compared to the control groups. However, intraspleenal cell implantation of 24x10^6 hepatocytes one day prior to liver surgery revealed a statistically significantly higher animal survival (72% vs. 29%). CONCLUSION: We established a model of HcTx which may present as the basis for further investigations evaluating potential treatment modalities to overcome liver insufficiency

Effect of immunosuppressive medication on postoperative complications following abdominal surgery in Crohn's disease patients

Background Immunosuppressants represent an efective pharmacological treatment for the remission and management of Crohn’s disease (CD); however, it has not been well-defned if these medications are associated with an increased incidence of postoperative complications after intestinal surgery. This retrospective study evaluated the association between immunosuppressive treatment and complications following bowel resection in patients with CD. Methods A total of 426 patients with CD who underwent abdominal surgery between 2001 and 2018 were included in the study. The participants were divided into two groups. In the frst group, patients were under immunosuppressive treatment at the time of surgical resection, while in the second group, patients had never received pharmacological therapy for CD before surgery. Results No statistically signifcant diference was found in the incidence of postoperative complications between the two groups. Double or triple immunosuppressive therapy was not associated with increased complications compared to monotherapy or no pharmacological treatment. Preoperative risk factors such as hypoalbuminemia, abscess, fstula, intestinal perforation, long duration of symptoms, and the intraoperative performance of more than one anastomosis were related to increased rates of postoperative complications. Factors afecting the occurrence of postoperative complications in the univariate analysis were included in the multivariate analysis using a stepwise logistic regression model, and these factors were also related to increased rates of postoperative surgical complications. Conclusion Immunosuppressive therapy was not associated with increased rates of postoperative complications following bowel resection in patients with CD