Laparoscopic gastric pouch and remnant resection: a novel approach to refractory anastomotic ulcers after Roux-en-Y Gastric Bypass: Case report
<p>Abstract</p> <p>Background</p> <p>Anastomotic or marginal ulcers occur in 0.6 to 16% of patients after laparoscopic Roux-en-Y-Gastric Bypass. Initial therapy aims at eliminating known risk factors including smoking, Helicobacter pylori infection, use of non-steroidal...
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| Format: | Article |
| Language: | English |
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BMC
2011-12-01
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| Series: | BMC Surgery |
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| Online Access: | http://www.biomedcentral.com/1471-2482/11/33 |
| _version_ | 1828926920999305216 |
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| author | Steinemann Daniel C Schiesser Marc Clavien Pierre-Alain Nocito Antonio |
| author_facet | Steinemann Daniel C Schiesser Marc Clavien Pierre-Alain Nocito Antonio |
| author_sort | Steinemann Daniel C |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>Anastomotic or marginal ulcers occur in 0.6 to 16% of patients after laparoscopic Roux-en-Y-Gastric Bypass. Initial therapy aims at eliminating known risk factors including smoking, Helicobacter pylori infection, use of non-steroidal anti-inflammatory drugs and inhibition of gastric acid secretion. While this approach is successful in 68 to 88% of the cases, up to one third of patients need a subsequent surgical revision. However, marginal ulcers still recur in up to 10% of cases after revisional surgery, thus constituting a serious challenge for bariatric surgeons.</p> <p>Case presentation</p> <p>We herein report a case of an insidious marginal ulcer refractory to both medical therapy with high-dosed proton pump inhibitors and sucralfate as well as surgical therapy consisting of the lengthening of a short alimentary limb and later resection of the gastroenterostomy and construction of a new tension-free anastomosis. Only after gastrectomy by laparoscopic en-bloc resection of the gastrojejunostomy, the gastric pouch and resection of the gastric remnant with reconstruction by esophagojejunostomy the patient remained free of symptoms.</p> <p>Conclusion</p> <p>By laparoscopic resection of the entire gastric pouch and the gastric remnant the risk to leave a suboptimally vascularised or even ischemic pouch in situ was avoided. The esophagojejunostomy was then created in healthy, good vascularised tissue. In our case this novel approach was effective in the management of a refractory anastomotic ulcer and might represent a rescue option when simple revision of the gastrojejunostomy fails.</p> |
| first_indexed | 2024-12-13T23:42:07Z |
| format | Article |
| id | doaj.art-a664b67e59044379a77587a033297140 |
| institution | Directory Open Access Journal |
| issn | 1471-2482 |
| language | English |
| last_indexed | 2024-12-13T23:42:07Z |
| publishDate | 2011-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Surgery |
| spelling | doaj.art-a664b67e59044379a77587a0332971402022-12-21T23:27:09ZengBMCBMC Surgery1471-24822011-12-011113310.1186/1471-2482-11-33Laparoscopic gastric pouch and remnant resection: a novel approach to refractory anastomotic ulcers after Roux-en-Y Gastric Bypass: Case reportSteinemann Daniel CSchiesser MarcClavien Pierre-AlainNocito Antonio<p>Abstract</p> <p>Background</p> <p>Anastomotic or marginal ulcers occur in 0.6 to 16% of patients after laparoscopic Roux-en-Y-Gastric Bypass. Initial therapy aims at eliminating known risk factors including smoking, Helicobacter pylori infection, use of non-steroidal anti-inflammatory drugs and inhibition of gastric acid secretion. While this approach is successful in 68 to 88% of the cases, up to one third of patients need a subsequent surgical revision. However, marginal ulcers still recur in up to 10% of cases after revisional surgery, thus constituting a serious challenge for bariatric surgeons.</p> <p>Case presentation</p> <p>We herein report a case of an insidious marginal ulcer refractory to both medical therapy with high-dosed proton pump inhibitors and sucralfate as well as surgical therapy consisting of the lengthening of a short alimentary limb and later resection of the gastroenterostomy and construction of a new tension-free anastomosis. Only after gastrectomy by laparoscopic en-bloc resection of the gastrojejunostomy, the gastric pouch and resection of the gastric remnant with reconstruction by esophagojejunostomy the patient remained free of symptoms.</p> <p>Conclusion</p> <p>By laparoscopic resection of the entire gastric pouch and the gastric remnant the risk to leave a suboptimally vascularised or even ischemic pouch in situ was avoided. The esophagojejunostomy was then created in healthy, good vascularised tissue. In our case this novel approach was effective in the management of a refractory anastomotic ulcer and might represent a rescue option when simple revision of the gastrojejunostomy fails.</p>http://www.biomedcentral.com/1471-2482/11/33Roux-en-Y-Gastric Bypassbariatric surgeryanastomotic ulcermarginal ulcerobesity |
| spellingShingle | Steinemann Daniel C Schiesser Marc Clavien Pierre-Alain Nocito Antonio Laparoscopic gastric pouch and remnant resection: a novel approach to refractory anastomotic ulcers after Roux-en-Y Gastric Bypass: Case report BMC Surgery Roux-en-Y-Gastric Bypass bariatric surgery anastomotic ulcer marginal ulcer obesity |
| title | Laparoscopic gastric pouch and remnant resection: a novel approach to refractory anastomotic ulcers after Roux-en-Y Gastric Bypass: Case report |
| title_full | Laparoscopic gastric pouch and remnant resection: a novel approach to refractory anastomotic ulcers after Roux-en-Y Gastric Bypass: Case report |
| title_fullStr | Laparoscopic gastric pouch and remnant resection: a novel approach to refractory anastomotic ulcers after Roux-en-Y Gastric Bypass: Case report |
| title_full_unstemmed | Laparoscopic gastric pouch and remnant resection: a novel approach to refractory anastomotic ulcers after Roux-en-Y Gastric Bypass: Case report |
| title_short | Laparoscopic gastric pouch and remnant resection: a novel approach to refractory anastomotic ulcers after Roux-en-Y Gastric Bypass: Case report |
| title_sort | laparoscopic gastric pouch and remnant resection a novel approach to refractory anastomotic ulcers after roux en y gastric bypass case report |
| topic | Roux-en-Y-Gastric Bypass bariatric surgery anastomotic ulcer marginal ulcer obesity |
| url | http://www.biomedcentral.com/1471-2482/11/33 |
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