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]

COVID-19: a catalyst for the digitization of surgical teaching at a German University Hospital

Background: The summer semester 2020, had to be restructured due to the SARS-CoV-2 pandemic and the associated contact restrictions. Here, for the frst time, the established lectures in lecture halls and small group seminars could not be conducted in presence as usual. A possible tool for the implementation of medical teaching, ofers the use of eLearning, online webinars and learning platforms. At present it is unclear how the SARS-CoV-2 pandemic will afect surgical teaching, how digitization will be accepted by students, and how virtual teaching can be expanded in the future. Methods: The teaching, which was previously delivered purely through face-to-face lectures, was completely converted to digital media. For this purpose, all lectures were recorded and were available to students on demand. The seminars were held as a twice a week occurring online webinar. The block internship was also conducted as a daily online webinar and concluded with an online exam at the end. At the end of the semester, a survey of the students was carried out, which was answered by n=192 students with an anonymized questionnaire. The questionnaire inquires about the previous and current experience with eLearning, as well as the possibility of a further development towards a purely digital university. Results: There were n=192 students in the study population. For 88%, the conversion of classes to web-based lectures represented their frst eLearning experience. For 77% of all students, the digitization of teaching led to a change in the way they prepare for class. 73% of the participating students are of the opinion that eLearning lectures should continue to be ofered. 54% of the students felt that eLearning lectures made more sense than face-to-face lectures. A purely virtual university could be imagined by 41% of the students. Conclusion: The conversion of teaching represented the frst contact with eLearning for most students. Overall, the eLearning ofering was experienced as positive. Due to the new teaching structure, the way of learning had already changed during the semester. Based on the new eLearning content, the already existing formats can be further expanded in the future. Nevertheless, it turned out that the practical-surgical contents and skills cannot be adequately represented by purely online ofers; for this, the development of hybrid practice-oriented teaching concepts is necessary

Repeated hepatic resection for colorectal liver metastases: is this concept safe and feasible?

Background: The beneficial outcomes of hepatectomy in patients with colorectal metastases have encouraged the attempts of repeated hepatectomy in patients with recurrent disease. Although studies have provided encouraging results regarding perioperative outcomes and survival rates following repeated hepatectomy, it remains unclear whether the reported outcomes reflect the therapeutic results of redo hepatectomy or rather reflect the effect of selection bias. The aim of this study was to investigate differences among patients who underwent single and repeated hepatectomy and to hereby identify prognostic factors that contribute to the premises of repeated resection. Methods: Patients who underwent hepatectomy due to colorectal metastases were listed in a retrospective database. Study participants were divided into a single partial hepatectomy group, a multiple partial hepatectomies group, and into subgroups of two or more than two hepatectomies. Results: A total of 338 patients with 439 partial liver resections were included in the analysis. The overall survival rate after 1, 3, and 5 years was 89%, 56%, and 36%, respectively. The survival benefit in patients who underwent multiple partial liver resections versus those with a single partial resection was 10%, 16%, and 4% after 1, 3, and 5 years, respectively. Repeated hepatectomy was not associated with increased rates of surgical and non-surgical complications. Conclusion: Beneficial outcomes have been found in terms of median overall survival and perioperative morbidity in patients with recurrence of colorectal hepatic metastases after partial and tissue-sparing repeated liver resections

Data_Meyer_et_al_-_Crop_identity_and_memory_effects_on_aboveground_arthropods_in_a_long-term_crop_rotation_experiment

In the dataset, we present data about the experimental design, management, soil mesofauna and aboveground species in a long-term crop rotation experiment

Crop identity and memory effects on aboveground arthropods in a long-term crop rotation experiment

Agricultural landscapes are globally dominated by monocultures under intensive management. This is one of the main reasons for biodiversity loss and insect population decline in many regions all over the world. Agroecosystem biodiversity in these areas can be enhanced by cropping system diversification, such as crop rotations. Yet, long‐term studies on effects of crop rotations on aboveground agrobiodiversity are lacking. We set up a 10‐year long‐term crop rotation experiment in Central Germany and monitored the temporal dynamics of aboveground arthropods over a full cultivation period to investigate influence of current and preceding crop identity and cropping system diversification on activity density, species richness, and community structure. We found that species composition was strongly influenced by currently grown crop although effect on arthropods varied between species groups. Especially, winter oilseed rape strongly affects arthropod community structure. Interestingly, we were also able to show an influence of the preceding crops, indicating an ecological memory effect in the aboveground arthropod community. Our results show that crop identity of both currently and previously grown crops in crop rotations may lead to an increase in arthropod activity density and changes in species composition. Diversified crop rotations including appropriate crops can be an easily implemented tool to increase arthropod biodiversity and biomass at large spatial and temporal scales, particularly in areas dominated by a single crop (e.g., wheat, maize). Our results may help to design optimized crop rotations for large‐scale enhancement of insect biodiversity in agroecosystems