These detectives accomplished a look at study, until from techniques and you can negative effects of bariatric Notes tips. A maximum of nine books were included in the finally study, with some other six papers outlining endolumenal tips provided having assessment. Most of the Notes education implemented a crossbreed techniques. Crossbreed Notes arm gastrectomy (hNSG) is demonstrated in the 4 individuals and you will dos porcine knowledge. Inside individuals, 6 sufferers (23.1 %) was indeed transformed into antique laparoscopic tips, and you may 1 blog post-medical side-effect (3.8 %) is reported. Indicate additional weight losings is actually 46.six % (list of thirty five.2 so you’re able to 58.9). The fresh new article authors figured transvaginal-aided sleeve gastrectomy seemed possible and safe whenever did of the rightly educated positives. But not, it stated that improvements have to be made to overcome current technology limits.
An UpToDate comment with the “Natural orifice transluminal endoscopic procedures (NOTES)” (Pasricha and you can Rivas, 2018) says that “Natural orifice transluminal endoscopic businesses (NOTES) are a growing occupation within this intestinal surgery and you can interventional gastroenterology for the that physician accesses this new peritoneal cavity via a hollow viscus and you can work symptomatic and you will therapeutic measures … You will find significantly more that must be heard of that it techniques, including the risk of peritoneal pollution. Up until now, the kupÃ³ny eharmony brand new available muscles from systematic experience doesn’t demonstrate deleterious outcomes linked to toxic contamination and you will further infection. Right now, Notes still should be thought about mostly fresh and should be performed simply into the research means”.
Candy cane disorder (CCS), which is also known as Roux syndrome otherwise Chocolate cane Roux syndrome, was an unusual complication when you look at the people just after Roux-en-Y gastric bypass operations. It happens if there’s a too high duration of roux limb proximal to help you gastrojejunostomy, carrying out the option to possess eating particles to help you resort and stay into the this new blind redundant limb.
Aryaie and colleagues (2017) noted that CCS has been implicated as a cause of abdominal pain, nausea, and emesis after RYGB; however, it remains poorly described. These investigators reported that CCS is real and can be treated effectively with revisional bariatric surgery. All patients who underwent resection of the “Candy cane” between were included in this study. Demographic data; pre-, peri-, and post-operative symptoms; data regarding hospitalization; and post-operative weight loss were examined via retrospective chart review. Data were analyzed using Student’s t test and ?2 analysis where appropriate. A total of 19 patients had resection of the “Candy cane” (94 % women, mean age of 50 ± 11 years), within 3 to 11 years after initial RYGB. Primary presenting symptoms were epigastric abdominal pain (68 %) and nausea/vomiting (32 %), especially with fibrous foods and meats. On upper gastro-intestinal (GI) study and endoscopy, the afferent blind limb was the most direct outlet from the gastrojejunostomy. Only patients with these pre-operative findings were deemed to have CCS; 18 (94 %) cases were completed laparoscopically. Length of the “Candy cane” ranged from 3 to 22 cm; median length of stay was 1 day. After resection, 18 (94 %) patients had complete resolution of their symptoms (p < 0.001). Mean BMI decreased from 33.9 ± 6.1 kg/m2 pre-operatively to 31.7 ± 5.6 kg/m2 at 6 months (17.4 % EWL) and 30.5 ± 6.9 kg/m2 at 1 year (25.7 % EWL). The average length of latest follow-up was 20.7 months. The authors concluded that CCS is a real phenomenon that could be managed safely with excellent outcomes with resection of the blind afferent limb. A thorough diagnostic work-up is critical for proper identification of CCS; and surgeons should minimize the size of the blind afferent loop left at the time of initial RYGB.
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