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 Table of Contents  
Year : 2016  |  Volume : 1  |  Issue : 1  |  Page : 37-39

Video Presentation

Date of Web Publication25-Oct-2016

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2542-4629.193046

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How to cite this article:
. Video Presentation. Saudi J Laparosc 2016;1:37-9

How to cite this URL:
. Video Presentation. Saudi J Laparosc [serial online] 2016 [cited 2022 Aug 11];1:37-9. Available from: https://www.saudijl.org/text.asp?2016/1/1/37/193046

  Late complication of gastric bypass Top

Moataz Mahmoud Mohamed Bashah


Laparoscopic Reux en Y Gastric Bypass (LREYGBP) is most of the most performing bariatric and metabolic procedure in the world due to its excellent result regarding weight loss and amelioration of associated co-morbidities. Late complication of LREYGBP need high index of suspicious, we will present 4 cases with video for diagnosis and management of it.

  Catastrophe during laparoscopic Reux en y gatsric bypass Top

Moataz Mahmoud Mohamed Bashah


Paying attention to details during LREYGBP procedure is essential to avoid intra operative catastrophes, we will present videos for 3 catastrophes and how to manage it.

  Sleeve gastrectomy the worst scenario, Sharjah experience (UAE) Top

Abdulwahid Alwahedi, Mahdy T, Edris F


Obesity is major public health problem worldwide with increase prevalence. And sleeve Gastrectomy is one of the treatment option, but it is associated with complication like any other surgical procedure, and leak is the worst complication post sleeve Gastrectomy, with leak rate incidence of 2-4%. Most of the leaks are difficult to interpret. Clinical signs are often silent and sometimes the only alarm sign of a possible complication is low grade fever or tachycardia. Management of post-operative leak is very challenging and it is better to prevent a leak than to be expert in managing leaks. But what is the main cause of leak? We think that the cause is multi-factorial, where surgeon, device, and tissue could play a role, and in some cases the cause will remain unknown. Each center can establish its own logarithm of treatment, but key success for any treatment is early detection, sepsis control, and good nutritional support. In this presentation we are going to present four videos of leak cases out of 8 cases of leaks in more than 800 cases of sleeve Gastrectomy in our center and each case had different presentation with different treatment and outcome. In four out of eight cases of leak the leak was associated with post-operative bleeding, which made us to be more conscious regarding the possibility of leak and post-operative bleeding.

  Revision of plication to sleeve is a technically feasible excellent option Top

Osamah Alsanie, Johnny Haddad

Somna Care, Procare Hospital, Al Khobar Saudi Arabia

Background: Gastric plication has been popularised as an alternative to sleeve gastrectomy with comparable weight loss. The advantages were in its reversibility and reduction of complication.

Materials and Methods: We describe four cases who underwent plication of which two patients had full gastric plication and one case had proximal plication following gastric bypass and the last case had antral plication along with sleeve gastrectomy of the body and fundus.

Results: All patients failed to have a meaningful weight loss except one patient and all patients had weight regain that resulted in almost reaching their pre procedure weight. All patients underwent unravelling of the plication before sleeving the stomach. No complications were associated with the procedure and in two patients, chronic disabling abdominal pain and reflux improved respectively.

Conclusion: Sleeving post gastric plication is feasible and unravelling the plication is important to achieve an ideal sleeve.

  Nissen to Roux en Y gastric bypass: When, who, and how? Top

Saud Al-Subaie, Salman Al-Sabah, Khalid Al-Enezi

Amiri Hospital, Kuwait City, Kuwait

Introduction: Nissen fundoplication is considered the standard surgical treatment of GERD, which, in normal weight individuals, is 93% effective in controlling reflux symptoms. In contrast, morbidly obese patients are four times more likely to experience a failed fundoplication than normal weight patients.

Presentation of Case: We present a case of a 43 year-old female (BMI, 36) with a background history of Nissen fundoplication in 2011 for severe GERD symptoms secondary to large sliding hiatal hernia in another center. Four years later, she presented to our clinic with recurrence & progression of GERD symptoms immediately after her surgery that became completely uncontrolled on antireflux medications. Double contrast CT and Water-Soluble contrast study revealed a large hiatal hernia with intra-thoracic migration of the fundoplication valve. This was confirmed by upper flexible endoscopy, which also showed grade B GERD. She underwent Nissen-to-RYGB. Postoperative recovery was uneventful. Two months later, she was asymptomatic and had an acceptable weight loss.

Conclusion: The decision to perform RYGB after fundoplication surgery in obese patients should be considered as one of the options of antireflux surgeries that the patient can benefit from, along with the advantages of weight loss. Such a decision is challenging, especially in a patient who have a recurrent GERD symptoms after the fundoplication surgery, since the operation will have high technical demands to take down the adhesions around the stomach and release the fundoplication valve, if possible, before the gastric pouch formation.

  Intra-operative endoscopy decreases postoperative complications in Laparoscopic Sleeve Gastrectomy Top

Abdelrahman Nimeri, Mohammed Al Hadad, El Nazeer Salim, Ali Al Hassani, Ahmed Maasher

Sheikh Khalifa Medical City, Abu Dhabi, UAE

Introduction: Laparoscopic sleeve gastrectomy (LSG) represents 42% of bariatric procedure done in USA in 2013 according to the ASBMS. Calibration of the stomach size is one of the essential technical steps of the procedure. Leak, bleeding, twist or stenosis after LSG are causes of major morbidity and mortality.

Aim: To evaluate the role of routine use of intraoperative endoscopy (IOE) in calibrating the size of the sleeve as well as reducing postoperative complications.

Methods: A retrospective review of all LSG done between November 2009 and February 2015. IOE was a routine procedure in all cases to check for leak, bleeding, twist and stenosis. If stenosis or a twist was detected, the over-sewing sutures were removed and the endoscopy is repeated. Postoperative oral intake is started once patient is fully awake without routine radiological studies and no drains were placed.

Results: During the study period we performed 279 LSG. The IOE showed a twist or a kink or narrowing in 9 (3.2%) cases near the incisura, the over sewing sutures were removed and endoscopy repeated. Our clinical leak and stenosis rate was 0%. Our success body weight loss at 1 year and two years were 71.6% and 73%.

Conclusion: The use of the endoscope as a calibration tube helped in identifying stenosis at the incisura intra-operatively which have reduced our clinical stenosis rate to 0% in LSG.

  Incidental Findings at Bariatric Surgery Top

Ahmed AlGarzaie

Saudi Arabia

Background: Preoperative evaluation and presumptive diagnosis do not always tell the whole story. Despite careful preoperative evaluation, asymptomatic lesions, which escape identification, will be encountered during bariatric surgery. Additional operations and/or procedures are often required to diagnose and treat a disease process.

Method: We are reporting 5 cases had incidental diagnosis preoperative or during the bariatric surgery, the first was Ectopic pancreas in the proximal jejunum found during mobilizing the alimentary limb in RY Gastric bypass, the second Carcinoid tumor in the fundus of the stomach and the patient had Sleeve Gastrectomy, the third left adrenal mass in the evaluation of internal hernia post gastric bypass and the patient had left laparoscopic adrenalectomy and repair of the internal hernias, the fourth Rt adrenalectomy for incidentalnoma with sleeve Gastrectomy and last old traumatic splenic cyst had fenestration and partial excision with mini gastric bypass.

Conclusion: In the high volume bariatric surgery centers to diagnose preoperative or intra-operative incidental masses is expected and the best option for the management of surgical patients come from accurate and complete diagnostic evaluation before surgical intervention and the Bariatric surgeon capable to manage in safe and excellent outcome. However, surprises still occur.

  Perforated anastomotic ulcers post gastric bypass are best managed by primary suturing and patching Top

Osamah Alsanie, Johnny Haddad

Somna Care, Procare Hospital, Al Khobar Saudi Arabia

Background: Ulceration at the gastrojejunostomy in RouxY gastric bypass or Single anastomosis gastric bypass are very difficult to treat and can represent an acute emergency or a chronic illness with failure to thrive if neglected.

Data: We review 3 cases of ulcerations at the gastrojejunostomy and the management used for each case.

Results: The first two cases represent two patients who are heavy smokers and social drinkers with No other comorbidities who underwent RouxY gastric bypass and Single anastomosis gastric bypass. Patient presented acutely with an acute abdomen not relieved by narcotics. Investigation revealed pneumoperitoneum and laparoscopy showed a perforated anastomotic ulcer. Management consisted of primary repair and patching. Case 3 represented a patient post gastric bypass who developed an internal hernia that was missed in diagnosis for a year and reached a BMI of 15 before surgical correction. Post operatively, the patient failed to gain weight though her obstruction has improved and she continued to suffer from nausea and vomiting. Endoscopy revealed a large penetrating posterior anastomotic ulcer. She failed to respond to medical therapy and had to be reversed to normal anatomy.

Conclusion: Ulceration at the gastrojejunostomy post bypass can be prevented but should be treated. Aggressively if it occurs to avoid both acute and chronic complications

  Conversional procedures for failed vertical banded gastroplasty Top

Osamah Alsanie, Johnny Haddad

Somna Care, Procare Hospital, Al Khobar Saudi Arabia

Background: Vertical Banded Gatsroplasty has been popularised in the open surgery era and early during the launch of laparoscopic bariatric surgery in the 90's. Most patients ultimately regain weight and many suffer from maladaptive eating secondary to stricture formation. There is no consensus as to the appropriate procedure to be performed in such patients.

Materials and Methods: All cases who have undergone VBG in their past have been reviewed. The surgical technique and the outcome of revision procedures are described.

Results: Six cases have been performed. The first three cases underwent conversion to RouxY gastric bypass above the level of the mesh and the vertical staple line was made medial to the old staple line. No excision was necessary as in all patients, the staple lines have dehisced preoperatively. Case 4 and 5 underwent sleeve gastrectomy in which most of the mesh was excised and the vertical staple line was excised along with the removed stomach. In case 6, the patient has had RouxY gastric bypass after her VBG but failed to lose any weight. Operatively, she suffered severe adhesions and the old mesh was excised partially during the procedure which included sleeving of the pouch and gastrojejunostomy, Postoperatively, the patient developed leak at the angle of Hess and was managed by laparoscopic drainage and feeding gastrostomy.

Conclusion: VBG conversion is feasible to both gastric bypass and sleeve gastrectomy.

  Incidental findings during sleeve gastrectomy at the Royal Hospital in Muscat - The indications for and value of simultaneous surgery Top

Reda Rabie, Bader Al Hadhrami, Ahmed Dawood, Raad Almehdi

The Royal Hospital, Muscat, Oman

Introduction: With Bariatric surgery gradually becoming a necessity for a large section of the population in Oman, including especially those with the metabolic syndrome this service started at the Royal Hospital in 2012. This study aims to evaluate the significance of concurrently conducting additional procedures at the time of Sleeve Gastrectomy whether this was planned or added incidentally at surgery.

Methods: Retrospective analysis from a prospective database of all Patients undergoing sleeve gastrectomy at our institute between 2012 and end 2014.

Results: During the study period there were 99 Sleeve gastrectomies done. This was an isolated procedure in 55 (55%). An additional cruroplasty and/ or hiatal hernia repair was done in 38%. Pathological Gallbladder identified preoperatively underwent Cholecystectomies in 10%. There were also a Splenectomy for ITP (1%), Diaphragmatic hernia (Bochdaleck) repair in (1%), and Ventral hernia repair (4%). Alternatively, Incidental procedures decided at the time of surgery were for gastric GISTs in 3(3%), gastric duplication cyst in1 (1%) and excisional biopsy of enlarged lymph nodes in 7%. In total, 38% patients had 2 procedures done and 6% had 3 procedures at surgery. There were no morbidities related to the additional procedures. Further analysis included a postoperative assessment of the benefit of hiatal repair on reflux features both old and de novo.

Conclusion: Bariatric procedures may include planned or incidental additions to the original operation. Sleeve gastrectomy is an ideal procedure in Oman (with high Gastric cancer prevalence) to ensure access to the remanent stomach in the future. The results highlight the importance of focused attention to the hiatus including planned hiatoplasty to avoid the refluxogenic progress in Sleeve gastrectomy. The challenge of balancing the increasingly limited theatre space in public hospitals, with any additional operative time in these cases, should not deter from offering the indicated procedure at the proper timing.

  Robotic bariatric surgery initial experience: Pros-and-cons Top

Ali Manea Alahmary

GNP Hospital, Jeddah, Saudi Arabia

Robotic surgery was introduced to the surgical field less than 15 years back. It has been shown that it is good for difficult cases which could not been done easily with ordinary laparoscopy. The only limit for its wide use in surgery is its cost. We are presenting our initial experience in aseer central hospital in using robotic in bariatric surgery.


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  In this article
Late complicatio...
Catastrophe duri...
Sleeve gastrecto...
Revision of plic...
Nissen to Roux e...
Intra-operative ...
Incidental Findi...
Perforated anast...
Conversional pro...
Incidental findi...
Robotic bariatri...

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