De novo gastric adenocarcinoma 1 year after sleeve gastrectomy in a transplant patient

AbstractIntroductionIt has been reported in the literature that upper gastrointestinal malignancies after bariatric surgery are mostly gastro-esophageal, although it is not clear whether bariatric surgery represents a risk factor for the development of esophageal and/or gastric cancer. We report a case of a de novo gastric adenocarcinoma occurring in a transplant patient 1 year after a laparoscopic sleeve gastrectomy.Presentation of caseA 44 year-old woman with a BMI of 38kg/m2, hypertension, type 1 diabetes mellitus, multiple malignancies and a pancreas transplant underwent laparoscopic sleeve gastrectomy. The patient presented with intense dysphagias during the follow up. Studies were performed and the diagnoses of grade 2/3 adenocarcinoma were made. The patient underwent a robotic assisted total gastrectomy with a roux-en-y intracorporeal esophagojejunostomy. The procedure resulted in multiple metastasic lymph nodes, focal and transmural invasions to multiple organs with a tumor free margin resection. The patient presented with a postoperative pleural effusion, with no further complications.DiscussionThe diagnosis of gastroesophageal cancer after bariatric surgery is usually late since these patients have common upper gastrointestinal symptoms related to the procedure that could delay the diagnosis. De novo gastric cancer after sleeve gastrectomy has only been reported in one instance, in contrast with other bariatric surgery procedures.ConclusionsNo direct relation has been established between sleeve gastrectomy and the development of gastric cancer. Robotic procedures allow for complex multiorgan resections, while preserving the benefits of minimally invasive surgery

Robotic Sleeve Gastrectomy After Liver Transplantation

Background: Obesity following liver transplantation is a common medical problem that increases the morbidity and mortality of patients. Still, no standard of treatment for this type of obesity has been identified. While bariatric surgery has been reported as an option, no specific procedure has been defined. Objective: The authors present a robotic sleeve gastrectomy as a suggested treatment option for a patient with increased BMI following a liver transplant. Setting: The University of Illinois at Chicago. Methods: A 62-year-old woman with a history of liver transplantation followed by obesity, with a BMI of 53 kg/m², underwent a robotic sleeve gastrectomy after being enrolled in the bariatric surgery program. Results: The procedure was successfully completed robotically. The operation lasted 158 minutes with minimal blood loss. There were no complications. At 3 months follow up, the patient’s BMI had decreased to 48 kg/m². Immunosuppressive drugs serum levels were unchanged following surgery and she remained at the same immunosuppressive therapy. Conclusion: Robotic sleeve gastrectomy represents a safe alternative for the treatment of obesity in a transplanted patient. The procedure provides good results with no alterations in the immunosuppressive therapy. Longer follow-up and additional data gained from a larger series is needed in order to make more definitive conclusions

Assessment of adrenal medulla function by means of 131I-Metaiodio- benzylguanidine after spleno-renal derivation according to Warren

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Structured training and competence assessment in colorectal robotic surgery : Results of a consensus experts round table

Background: A structured training is a key element for the learning of techniques with a high level of complexity, such as robotic colorectal surgery. Methods: This study reports the results of an expert consensus round table held during the 6th Clinical Robotic Surgery Association (CRSA) congress, focusing on recommendations in robotic colorectal surgery. Results: Three sequential steps are proposed for training: a basic module, to learn basic robotic skills and general competencies; an advanced module, to acquire skills to safely perform a colorectal resection, and tutored clinical practice providing procedures of increasing complexity. Each specific skill of the basic module and performance of each surgical step of a colorectal procedure was evaluated and rated from 1 to 3. Conclusions: Defining requirements to begin robotic colorectal activity, delineation of structured training programs and objectification of the acquired competences are key elements for a safe and efficient learning of robotic colorectal surgery