Endoscopic Management of Strictures and Leaks. Prepared by Aurora D. Pryor, MD Presented by Dana Portenier, MD Duke University Medical Center

Size: px
Start display at page:

Download "Endoscopic Management of Strictures and Leaks. Prepared by Aurora D. Pryor, MD Presented by Dana Portenier, MD Duke University Medical Center"

Transcription

1 Endoscopic Management of Strictures and Leaks Prepared by Aurora D. Pryor, MD Presented by Dana Portenier, MD Duke University Medical Center

2 What can go wrong? Bleeding (2%) Sleeve too big Angulated Too narrow/stricture (1%) Leak (0.7-5%) J GI Surgery. 14(9):1343-8, 2010 Sep.

3 What can go wrong? Sleeve too big Angulated Too narrow/stricture Leak Courtesy Mohammed Alkayyal,

4 All bariatric surgeons should know how to manage leaks and strictures

5 Sleeve Complications: Stricture Stricture may occur on the long staple line Ischemia Oversewing Other Technical Issue Leak or bleeding may predispose to stricture. Surgical Endoscopy. 17(3):416-20, 2003 Mar.

6 Complications: Stricture Most strictures can be effectively managed with balloon dilation. May require a second session, but over 90% are managed with 1 or 2 dilations. Perforation is reported in 2% of patients in some larger series (2/94). Rosenthal. Surgery for Obesity & Related Diseases. 2(2):92-7, 2006 Mar-Apr. Nguyen. Journal of Gastrointestinal Surgery. 7(8): , 2003 Dec. American Journal of Surgery. 189(3):357-60, 2005 Mar. Gastrointestinal Endoscopy. 66(2):248-52, 2007 Aug.

7 Complications: Stricture Balloon dilators of mm have been described. To minimize recurrence, an 18 mm balloon is preferred. Procedure may be done with fluoroscopic assistance Inflate the balloon and hold for 1 minute Repeat if necessary Nguyen. Journal of Gastrointestinal Surgery. 7(8): , 2003 Dec. Surgical Endoscopy. 17(3):416-20, 2003 Mar.

8 What if Dilation Fails? Dapri. Laparoscopic Seromyotomy for Stricture after Sleeve. 9 patients, 1 leak. Good success. Obesity Surgery. 19(4):495-9, 2009 Apr. Sudan. Robotically assisted stricturoplasty. Eubanks. 5/6 strictures success with stents JACS. 2006(5):935-8

9 Sedation of the obese Dosage adjustments? Midazolam prolonged half life in the obese Fentanyl should be dosed on lean body mass, not total body weight No change in elimination half life in lean vs. obese Recovery time may be increased Casati. Journal of Clinical Anesthesia 2005

10 Sedation of the obese Obesity hypoventilation syndrome Alveolar hypoventilation Increased PCO2 Decreased PO2 Capnography Casati et al Journal of Clinical Anesthesia 2005

11 Sleeve Complications: Leak Obesity Surgery (2010) 20:

12 Sleeve Complications: Leak Most early uncontained leaks are operatively managed. Contained or delayed leaks may be managed nonoperatively in the stable patient. Endoscopic techniques are a useful adjunct. If combined with stricture, unlikely to heal.

13 Literature Review Nguyen. 3 pts with leak, all successfully treated with stenting Obesity Surgery. 20(9): , 2010 Sep. Csendes operative management of leaks. Resuturing ineffective after 3 days. Drainage alone averaged 45 days to resolution Journal of Gastrointestinal Surgery. 14(9):1343-8, 2010 Sep.

14 Literature Review Tan. 14 (10 referred) sleeve leaks 8 treated non-operatively with drainage operative management included drains 4 successfully stented 4 stent cx (migration x 2, bleeding, deployment problem) 1 pt required RY Esophagojejunostomy Obesity Surgery (2010) 20:

15 Sleeve Complications: Leak Most leaks occur at / near the angle of His Difficult to suture tissues at site of leak. Sutured leaks frequently recur. Cannot divert to promote healing. Only surgical management is often drainage. T-tube or foley in leak itself Wide peritoneal drainage 22% mortality of surgically managed GI leak. American Surgeon. 72(7):586-90; discussion 590-1, 2006 Jul.

16 Indicators of Leak Parameter Mean +/- SD No. of patients with (+) findings Epigastric pain 11 (68.7%) Fever > ±0.7 ( ) 13 (81.2%) Tachycardia > /min Leukocytosis >10,000/mm3 115±9.6 ( ) 7 (43.7%) 15,775±3,148 (10,600 22,300) 12 (75%) Left deviation > 4% 10.4±5.5 (7 29) 5 (31.2%) CRP mg/lt>11 268±107 (69 547) 16 (100%) J GI Surg. 14(9):1343-8, 2010 Sep

17 Operative options Widely drain Foley catheter in leak Graham patch Stent

18 RYGB Complications: Anastomotic Leak

19 Sleeve Complications: Leak Use of stents: Removable stents have been used as an adjunct for healing fistulae. Used extensively with esophageal injuries Fewer studies after bariatric surgery Simple to deploy Major concern is stent migration

20 Stenting 21 patients underwent endoscopic treatment for persisting large leaks before considering redo surgery. 8 RYGB 12 sleeve gastrectomy, 8 also with DS 1 BPD 15 GC, 2 DC, 3 GP, GB Fistulas Partially covered self-expanding metal stents (SEMSs) were used, followed by additional endoscopic procedures if the SEMS failed. SEMSs were removed by traction alone or by insertion of a selfexpanding plastic stent (SEPS) followed by extraction of both stents together. SEMS insertion led to 62 % (13/21) primary closures. 8/8 RYGB Complementary endoscopic treatment led to 4 secondary closures. Endoscopy. 39(7):625-30, 2007 Jul.

21 Newer Stent recommendations May feed early Keep at least 2 weeks Major complication is migration Nested stents may help Usually caught by pylorus

22

23

24 Sleeve Complications: Leak Use of endoscopically injected fibrin glue: Easy deployment, low risk procedure. Successful in 5/5, mean LOS 13.5 days versus 66 days in 3 surgically treated patients not randomized. Surgery for Obesity & Related Diseases. 3(4):438-42, 2007 Jul-Aug. Gastrointestinal Endoscopy. 66(6): , December 2007.

25 Stenting versus Fibrin Glue? Both are straightforward and often successful Stenting requires a follow-up procedure for stent removal. Glue may be successful with only one endoscopic procedure Limited published cases on the use of glue. More data is needed to compare these modalities.

26 Conclusions Many complications from sleeve gastrectomy may be treated endoscopically. Endoscopic therapy may minimize morbidity when compared to surgery. Considerations need to be taken with conscious sedation in the morbidly obese. May require more than one treatment. Outcomes are generally good with low risk.

Endoscopic therapy for obesity and complications of bariatric surgery

Endoscopic therapy for obesity and complications of bariatric surgery Endoscopic therapy for obesity and complications of bariatric surgery Jacques Devière, MD, PhD Erasme University Hospital Brussels Belgium jacques.deviere@erasme.ulb.ac.be Obesity Affects 300 millions

More information

When, Why, and How to Revise a Failed Sleeve Gastrectomy

When, Why, and How to Revise a Failed Sleeve Gastrectomy When, Why, and How to Revise a Failed Sleeve Gastrectomy Jin S. Yoo M.D. Assistant Professor of Surgery Duke University Medical Center April 6, 2013 When and Why Already Covered Let s Talk About How Overview

More information

Acute Abdominal Pain following Bariatric Surgery. Disclosure. Objectives 8/17/2015. I have nothing to disclose

Acute Abdominal Pain following Bariatric Surgery. Disclosure. Objectives 8/17/2015. I have nothing to disclose Acute Abdominal Pain following Bariatric Surgery Kathy J. Morris, DNP, APRN, FNP C, FAANP University of Nebraska Medical Center College of Nursing Disclosure I have nothing to disclose Objectives Pathophysiology

More information

Surgical & Nutritional Complications of Bariatric Surgery: What Every GI Doc Needs to Know Brian R. Smith, MD, FACS Associate Clinical Professor of

Surgical & Nutritional Complications of Bariatric Surgery: What Every GI Doc Needs to Know Brian R. Smith, MD, FACS Associate Clinical Professor of Surgical & Nutritional Complications of Bariatric Surgery: What Every GI Doc Needs to Know Brian R. Smith, MD, FACS Associate Clinical Professor of Surgery & Associate Residency Program Director UC Irvine

More information

Intraoperative Prevention of Stenosis for Laparoscopic Sleeve Gastrectomy

Intraoperative Prevention of Stenosis for Laparoscopic Sleeve Gastrectomy CASE REPORT Intraoperative Prevention of Stenosis for Laparoscopic Sleeve Gastrectomy Ramon Vilallonga, MD, PhD, Jacques Himpens, MD Division of Bariatric Surgery, AZ St. Blasius, Dendermonde, Belgium

More information

Scott A. Shikora, MD, FACS. Sleeve Gastrectomy. Sleeve Gastrectomy. Sleeve Gastrectomy 11/8/2013

Scott A. Shikora, MD, FACS. Sleeve Gastrectomy. Sleeve Gastrectomy. Sleeve Gastrectomy 11/8/2013 DISCLOSURE Scott A. Shikora, MD, FACS Scott A. Shikora, MD, FACS Associate Professor of Surgery Harvard Medical School Director, Center for Metabolic and Bariatric Surgery Brigham and Women s Hospital

More information

11/10/2014. I have nothing to Disclose. Covered Stents discussed are NOT FDA approved for the indications covered in my presentation

11/10/2014. I have nothing to Disclose. Covered Stents discussed are NOT FDA approved for the indications covered in my presentation I have nothing to Disclose Ramsey Dallal, MD, FACS Vice Chair Department of Surgery Chief Bariatric i and Minimally i Invasive Surgery Einstein Healthcare Network Nemacolin, PA 2014 Covered Stents discussed

More information

The hidden endoscopic burden of sleeve gastrectomy and its comparison with Roux-en-Y gastric bypass

The hidden endoscopic burden of sleeve gastrectomy and its comparison with Roux-en-Y gastric bypass ORIGINAL ARTICLE Annals of Gastroenterology (2015) 28, 1-6 The hidden endoscopic burden of sleeve gastrectomy and its comparison with Roux-en-Y gastric bypass Katherine Arndtz a, Helen Steed b, James Hodson

More information

23/06/2014. Objectives. Bariatric Patients. Endoscopic Management of Post Bariatric Surgery

23/06/2014. Objectives. Bariatric Patients. Endoscopic Management of Post Bariatric Surgery Endoscopic Management of Post Bariatric Surgery Greg Lutzak BSC, MD, FRCPC University of Alberta Royal Alexandra Hospital June 6, 2014 Objectives 1) Review common bariatric complications encountered in

More information

Endoscopic gastric pouch plication - a novel endoluminal incision free approach to revisional bariatric surgery

Endoscopic gastric pouch plication - a novel endoluminal incision free approach to revisional bariatric surgery Endoscopic gastric pouch plication - a novel endoluminal incision free approach to revisional bariatric surgery Authors: Chiranjiv S Virk, I Michael Leitman and Elliot R Goodman. Location: Beth Israel

More information

Case Report Successful Management of a Gastric Sleeve Leak with an Endoscopic Stent

Case Report Successful Management of a Gastric Sleeve Leak with an Endoscopic Stent Case Reports in Gastrointestinal Medicine Volume 2012, Article ID 205979, 4 pages doi:10.1155/2012/205979 Case Report Successful Management of a Gastric Sleeve Leak with an Endoscopic Stent Albin Abraham,

More information

Overview of Bariatric Surgery

Overview of Bariatric Surgery Overview of Bariatric Surgery To better understand how weight loss surgery works, it is helpful to know how the normal digestive process works. As food moves along the digestive tract, special digestive

More information

Use of stents in esophageal cancer" Hans Gerdes, M.D. Director, GI Endoscopy Unit Memorial Sloan-Kettering Cancer Center

Use of stents in esophageal cancer Hans Gerdes, M.D. Director, GI Endoscopy Unit Memorial Sloan-Kettering Cancer Center Use of stents in esophageal cancer" Hans Gerdes, M.D. Director, GI Endoscopy Unit Memorial Sloan-Kettering Cancer Center Features of esophageal cancer Esophageal cancer is an abnormal growth that arises

More information

Sleeve gastrectomy or gastric bypass as revisional bariatric procedures: retrospective evaluation of outcomes. Abstract Background Methods:

Sleeve gastrectomy or gastric bypass as revisional bariatric procedures: retrospective evaluation of outcomes. Abstract Background Methods: Sleeve gastrectomy or gastric bypass as revisional bariatric procedures: retrospective evaluation of outcomes. Mousa Khoursheed, Ibtisam Al-Bader, Ali Mouzannar, Abdulla Al-Haddad, Ali Sayed, Ali Mohammad,

More information

Weight loss surgery more than just a gastric band

Weight loss surgery more than just a gastric band Weight loss surgery more than just a gastric band Presented by Ms Beth Murgatroyd Honorary Bariatric Nurse Practitioner Mr Ameet G Patel Consultant Surgeon Director of Bariatric Surgery at King s College

More information

Roux-en-Y Gastric Bypass

Roux-en-Y Gastric Bypass Roux-en-Y Gastric Bypass Restrictive and malabsorptive procedure Most frequently performed bariatric procedure in the US First done in 1967 Laparoscopic since 1993 75% EWL in 18-24 months 50% EWL is still

More information

Dept. of Medical Imaging University of Ottawa

Dept. of Medical Imaging University of Ottawa ED Visits Related to Bariatric Surgery: Review of Normal Post-Surgical Anatomy as Well as Complications Dept. of Medical Imaging University of Ottawa Disclosures Background Roux-en-Y Gastric Bypass Surgery

More information

Bariatric i Surgery: Optimalizing Outcome Results. Dr. B. Dillemans AZ Sint-Jan AV Brugge-Oostende BARIATRIC SURGERY

Bariatric i Surgery: Optimalizing Outcome Results. Dr. B. Dillemans AZ Sint-Jan AV Brugge-Oostende BARIATRIC SURGERY Bariatric i Surgery: Optimalizing i Outcome Results Dr. B. Dillemans AZ Sint-Jan AV Brugge-Oostende THE OBESE PATIENT : A CHALLENGE FOR ANAESTHESIA, Ostend,14/11/09 BARIATRIC SURGERY 50 s : First Reported

More information

Considering Bariatric Surgery? Learn about minimally invasive da Vinci Surgery

Considering Bariatric Surgery? Learn about minimally invasive da Vinci Surgery Considering Bariatric Surgery? Learn about minimally invasive da Vinci Surgery The Condition: Obesity Obesity is defined as having a body mass index (BMI) of 30 or greater. Obesity is a serious medical

More information

Richard M Peterson, MD MPH FACS Chief UT Medicine Center for Bariatric and Metabolic Surgery Director Christus Weight Loss Institute Assistant

Richard M Peterson, MD MPH FACS Chief UT Medicine Center for Bariatric and Metabolic Surgery Director Christus Weight Loss Institute Assistant Richard M Peterson, MD MPH FACS Chief UT Medicine Center for Bariatric and Metabolic Surgery Director Christus Weight Loss Institute Assistant Professor of Surgery UTHSCSA None Laparoscopic adjustable

More information

Surgical management of chronic fistula after sleeve gastrectomy

Surgical management of chronic fistula after sleeve gastrectomy Surgery for Obesity and Related Diseases 9 (2013) 879 884 Original article Surgical management of chronic fistula after sleeve A. Marius Nedelcu, M.D. *, Mehdi Skalli, M.D., Eric Deneve, M.D., Jean Michel

More information

Preoperative drainage is always indicated in malignant CBD strictures PRO. Horst Neuhaus Evangelisches Krankenhaus Düsseldorf, Germany

Preoperative drainage is always indicated in malignant CBD strictures PRO. Horst Neuhaus Evangelisches Krankenhaus Düsseldorf, Germany Preoperative drainage is always indicated in malignant CBD strictures PRO Horst Neuhaus Evangelisches Krankenhaus Düsseldorf, Germany Background Jaundice is associated with high perioperative morbidity

More information

Endoluminal Bariatric Revision. Todd David Wilson, MD

Endoluminal Bariatric Revision. Todd David Wilson, MD Endoluminal Bariatric Revision Todd David Wilson, MD Surgical Endoscopy and the Bariatric Surgeon Preoperative Endoscopy Postoperative Endoscopy Revisional Endoscopy Primary Endoluminal Bariatrics Preoperative

More information

USE OF STENTS FOR UPPER GI DISASTERS. Michael Talbot. The St George Hospital, Sydney

USE OF STENTS FOR UPPER GI DISASTERS. Michael Talbot. The St George Hospital, Sydney USE OF STENTS FOR UPPER GI DISASTERS Michael Talbot. The St George Hospital, Sydney Disclosures Educational grants by Coviden, Applied Medical, Endogastric Solutions and Allergan in the last 3 years Clinical

More information

5. Conversion Procedures that change from an index procedure to a different type of procedure.

5. Conversion Procedures that change from an index procedure to a different type of procedure. Benefit Coverage Covered Benefit for lines of business including Health Benefits Exchange (HBE), Rite Care (MED), Children with Special Needs (CSN), Substitute Care (SUB), Rhody Health Partners (RHP),

More information

Emergencies in Post- Bariatric Surgery Patients

Emergencies in Post- Bariatric Surgery Patients Emergencies in Post- Patients Disclosures Dr. Birnbaumer has no financial disclosures Diane M. Birnbaumer, M.D., FACEP Professor of Medicine University of California, Los Angeles Senior Clinical Educator

More information

Emerging Concepts in Bariatric Surgery

Emerging Concepts in Bariatric Surgery Emerging Concepts in Bariatric Surgery C Y N T H I A L. L O N G, M D, F A C S S I N A I H O S P I T A L O F B A L T I M O R E D E P A R T M E N T O F S U R G E R Y D I V I S I O N O F M I N I M A L L Y

More information

Weight Loss before Hernia Repair Surgery

Weight Loss before Hernia Repair Surgery Weight Loss before Hernia Repair Surgery What is an abdominal wall hernia? The abdomen (commonly called the belly) holds many of your internal organs. In the front, the abdomen is protected by a tough

More information

Obesity When to Recommend Surgery. Lily Chang, MD September 27, 2013

Obesity When to Recommend Surgery. Lily Chang, MD September 27, 2013 Obesity When to Recommend Surgery Lily Chang, MD September 27, 2013 Obesity BMI >30 Trends Among U.S. Adults Source: Behavioral Risk Factor Surveillance System, CDC, 2012 Obesity Related Co-Morbidities

More information

Surgical Treatment. Type II Diabetes in. Obesity. for. Mathew Rawlins, MD FACS Rockwood Bariatric Specialists

Surgical Treatment. Type II Diabetes in. Obesity. for. Mathew Rawlins, MD FACS Rockwood Bariatric Specialists Surgical Treatment for Type II Diabetes in Obesity Mathew Rawlins, MD FACS Rockwood Bariatric Specialists Co-Morbidities of Obesity Coronary Disease Hypertension Dyslipidemias Pulmonary insufficiency

More information

WallFlex Biliary RX Stent. Fully, Partially and Uncovered Self-Expanding Metal Stents

WallFlex Biliary RX Stent. Fully, Partially and Uncovered Self-Expanding Metal Stents WallFlex Biliary RX Stent Fully, Partially and Uncovered Self-Expanding Metal Stents WallFlex Biliary RX Stent Fully, Partially and Uncovered Self-Expanding Metal Stents The WallFlex Biliary RX Stent is

More information

Choices Around Bariatric Surgery

Choices Around Bariatric Surgery Choices Around Bariatric Surgery What should you know? Richard Stubbs MD FRCS FRACS Wakefield Obesity Clinic, Wellington 152 kg / BMI 59 74 kg / BMI 29 Indications (NIH Consensus Statement 1991) BMI >

More information

Informed Consent for Laparoscopic Vertical Sleeve Gastrectomy. Patient Name

Informed Consent for Laparoscopic Vertical Sleeve Gastrectomy. Patient Name Informed Consent for Laparoscopic Vertical Sleeve Gastrectomy Patient Name Please read this form carefully and ask about anything you may not understand. I consent to have a laparoscopic Vertical Sleeve

More information

Types of Bariatric Procedures. Tejal Brahmbhatt, MD General Surgery Teaching Conference April 18, 2012

Types of Bariatric Procedures. Tejal Brahmbhatt, MD General Surgery Teaching Conference April 18, 2012 Types of Bariatric Procedures Tejal Brahmbhatt, MD General Surgery Teaching Conference April 18, 2012 A Brief History of Bariatric Surgery First seen in pts with short bowel syndrome weight loss First

More information

Open Ventral Hernia Repair

Open Ventral Hernia Repair Ventral Hernias Open Ventral Hernia Repair UCSF Postgraduate Course in General Surgery Maui, HI March 21, 2011 Hobart W. Harris, MD, MPH Ventral Hernias: National Experience Occur following 11-23% of laparotomies,

More information

Technical Aspects of Bariatric Surgical Procedures. Robert O. Carpenter, MD, MPH, FACS Department of Surgery Scott & White Memorial Hospital

Technical Aspects of Bariatric Surgical Procedures. Robert O. Carpenter, MD, MPH, FACS Department of Surgery Scott & White Memorial Hospital Technical Aspects of Bariatric Surgical Procedures Robert O. Carpenter, MD, MPH, FACS Department of Surgery Scott & White Memorial Hospital Disclosures Allergan, Inc. (Past) Faculty Member Educational

More information

Redo Banding After Band Erosion Advantages of the MiniMizer Extra Band Conclusion Approximately 67% of the patients suffering from erosion have sought revisional surgery. The choice of redo procedures

More information

Laparoscopic Inguinal Hernia Repair Surgery Patient Information from SAGES

Laparoscopic Inguinal Hernia Repair Surgery Patient Information from SAGES Laparoscopic Inguinal Hernia Repair Surgery Patient Information from SAGES About Your Inguinal Hernia and Laparoscopic Repair: Approximately 600,000 inguinal or groin hernia repair operations are performed

More information

Severe Events Related to Use of Stents in Bariatric Surgical Complications

Severe Events Related to Use of Stents in Bariatric Surgical Complications CASE REPORT Severe Events Related to Use of Stents in Bariatric Surgical Complications Angelo Iossa, MD, Fausto Fiocca, MD, Mario Corona, MD, Giuseppe Cavallaro, MD, PhD, Fabrizio Cereatti, MD, Mario Rizzello,

More information

Contraindications: Malign or benign strictures in the upper part of esophagus close to the cricopharyngeal muscle.

Contraindications: Malign or benign strictures in the upper part of esophagus close to the cricopharyngeal muscle. Manufactured by: ELLA CS, s.r.o. Milady Horákové 504 500 06 Hradec Králové 6 Czech Republic Phone: +420 49 527 91 11 Fax: +420 49 526 56 55 E-mail: volenec@ellacs.cz Instructions for Use FerX-ELLA Esophageal

More information

Massive Ventral Hernias

Massive Ventral Hernias Ventral Hernias Massive Ventral Hernias Postgraduate Course in General Surgery JW Marriott Ihilani Oahu, HI March 26, 2012 Hobart W. Harris, MD, MPH Ventral Hernias: National Experience Occur following

More information

Benign Esophageal Perforations: Better Keep a Surgeon in the Toolkit

Benign Esophageal Perforations: Better Keep a Surgeon in the Toolkit Benign Esophageal Perforations: Better Keep a Surgeon in the Toolkit Bryan F. Meyers MD MPH Patrick and Joy Williamson Professor of Surgery Background Esophageal perforation is a difficult problem to characterize,

More information

ESPEN Congress Geneva 2014 LLL LIVE COURSE: NUTRITION IN OBESITY

ESPEN Congress Geneva 2014 LLL LIVE COURSE: NUTRITION IN OBESITY ESPEN Congress Geneva 2014 LLL LIVE COURSE: NUTRITION IN OBESITY Pre-operative medical assessment, post-operative follow-up and clinical outcome in bariatric surgery patients A. Thorell (SE) Nutrition

More information

Outcomes and options in the management of leak and gastric fistula after sleeve gastrectomy.

Outcomes and options in the management of leak and gastric fistula after sleeve gastrectomy. Outcomes and options in the management of leak and gastric fistula after sleeve gastrectomy. 1 Mercy Bariatrics, Perth Australia Leon Cohen 1 Leak and gastric fistula after sleeve gastrectomy remains one

More information

Informed Consent for Laparoscopic Roux en Y Gastric Bypass. Patient Name

Informed Consent for Laparoscopic Roux en Y Gastric Bypass. Patient Name Informed Consent for Laparoscopic Roux en Y Gastric Bypass Patient Name Please read this form carefully and ask about anything you may not understand. I consent to have a laparoscopic Roux en Y Gastric

More information

Roux-en-y gastric bypass - clinical perspectives

Roux-en-y gastric bypass - clinical perspectives Roux-en-y gastric bypass - clinical perspectives Tom Mala Consultant surgeon Department of Gastroenterologic Surgery Oslo University Hospital Bariatric surgery weight loss Sjøstrøm L, JAMA 2012 Five-year

More information

Transoral gastric volume reduction for weight management: technique and feasibility in 18 patients

Transoral gastric volume reduction for weight management: technique and feasibility in 18 patients Surgery for Obesity and Related Diseases 6 (2010) 689 694 Video original article Transoral gastric volume reduction for weight management: technique and feasibility in 18 patients Stacy A. Brethauer, M.D.

More information

Evidence tabel Lokaal palliatieve behandelingen

Evidence tabel Lokaal palliatieve behandelingen Auteurs, jaartal Mate van bewijs Studie type Follow-up Populatie (incl. steekproef-grootte) Patienten kenmerken Interventie Controle Resultaten Conclusie Opmerkingen, commentaar Hartgrink, 2002 The Netherlands

More information

Novel treatments for complications after bariatric surgery

Novel treatments for complications after bariatric surgery DOI 10.1186/s13022-015-0021-2 REVIEW Open Access Novel treatments for complications after bariatric surgery Julián Hernández 1 and Camilo Boza 2* Abstract Bariatric surgery has been considered one of best

More information

Endoluminal and Laparoscopic Bariatric & Metabolic Surgery Advanced Course

Endoluminal and Laparoscopic Bariatric & Metabolic Surgery Advanced Course Endoluminal and Laparoscopic Bariatric & Metabolic Surgery Advanced Course Directors of the course: Jacques MARESCAUX Michel VIX Manoel GALVAO NETO Silvana PERRETTA France France Brazil Italy Faculty:

More information

Laparoscopic One Anastomosis Gastric Bypass (LOAGB) How I do it

Laparoscopic One Anastomosis Gastric Bypass (LOAGB) How I do it CENTER OF EXCELLENCE FOR THE STUDY AND OBESITY TREATMENT Laparoscopic One Anastomosis Gastric Bypass (LOAGB) How I do it Concepts and Results in a series of 11-years experience with 2,200 patients Miguel-A.

More information

Gastric Stenosis After Laparoscopic Sleeve Gastrectomy in Morbidly Obese Patients

Gastric Stenosis After Laparoscopic Sleeve Gastrectomy in Morbidly Obese Patients OBES SURG (2013) 23:1481 1486 DOI 10.1007/s11695-013-0963-6 REVIEW Gastric Stenosis After Laparoscopic Sleeve Gastrectomy in Morbidly Obese Patients Ana María Burgos & Attila Csendes & Italo Braghetto

More information

Laparoscopic Revisional Gastric Bypass after open bariatric surgeries. Haider Alshurafa 1

Laparoscopic Revisional Gastric Bypass after open bariatric surgeries. Haider Alshurafa 1 Laparoscopic Revisional Gastric Bypass after open bariatric surgeries 1 Surgery Department, Riyadh Military Hospital, Riyadh, Saudi Arabia Haider Alshurafa 1 Objective: To confirm the feasibility of the

More information

PATIENT CONSENT TO PROCEDURE - ROUX-EN-Y GASTRIC BYPASS

PATIENT CONSENT TO PROCEDURE - ROUX-EN-Y GASTRIC BYPASS As a patient you must be adequately informed about your condition and the recommended surgical procedure. Please read this document carefully and ask about anything you do not understand. Please initial

More information

Bariatric Surgery: What the Internist Needs to Know

Bariatric Surgery: What the Internist Needs to Know Bariatric Surgery: What the Internist Needs to Know Richard Stahl, MD, FACS Assistant Professor of Surgery Medical Director of Bariatric Surgery Disclosures None (sadly) Objectives Describe several myths

More information

Urinary Diversion: Ileovesicostomy/Ileal Loop/Colon Loop

Urinary Diversion: Ileovesicostomy/Ileal Loop/Colon Loop Urinary Diversion: Ileovesicostomy/Ileal Loop/Colon Loop Why do I need this surgery? A urinary diversion is a surgical procedure that is performed to allow urine to safely pass from the kidneys into a

More information

Successful Management of Refractory Staple Line Leakage at the Esophagogastric Junction After a Sleeve Gastrectomy Using the HANAROSTENT

Successful Management of Refractory Staple Line Leakage at the Esophagogastric Junction After a Sleeve Gastrectomy Using the HANAROSTENT DOI 10.1007/s11695-009-9976-6 CASE REPORT Successful Management of Refractory Staple Line Leakage at the Esophagogastric Junction After a Sleeve Gastrectomy Using the HANAROSTENT Takashi Oshiro & Kazunori

More information

Gastric Leak After Laparoscopic-Sleeve Gastrectomy for Obesity

Gastric Leak After Laparoscopic-Sleeve Gastrectomy for Obesity DOI 10.1007/s11695-009-9884-9 RESEARCH ARTICLE Gastric Leak After Laparoscopic-Sleeve Gastrectomy for Obesity Ana Maria Burgos & Italo Braghetto & Attila Csendes & Fernando Maluenda & Owen Korn & Julio

More information

Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI)

Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) The American Society for Gastrointestinal Endoscopy PIVI on Endoscopic Bariatric Procedures (short form) Please see related White

More information

Documentation Guidelines for Physicians Interventional Pain Services

Documentation Guidelines for Physicians Interventional Pain Services Documentation Guidelines for Physicians Interventional Pain Services Pamela Gibson, CPC Assistant Director, VMG Coding Anesthesia and Surgical Divisions 343.8791 1 General Principles of Medical Record

More information

Gary M. Annuniziata, D.O., F.A.C.P. Anh T. Duong, M.D. Jonathan C. Lin, M.D., MPH. Preparation for EGD, ERCP, Peg Placement.

Gary M. Annuniziata, D.O., F.A.C.P. Anh T. Duong, M.D. Jonathan C. Lin, M.D., MPH. Preparation for EGD, ERCP, Peg Placement. Gary M. Annuniziata, D.O., F.A.C.P. Anh T. Duong, M.D. Jonathan C. Lin, M.D., MPH Phone- (760) 321-2500 Fax- (760) 321-5720 Preparation for EGD, ERCP, Peg Placement Patient Name- Procedure Date and Time-

More information

Treatment of Maxillary Sinusitis Using the SinuSys Vent-Os Sinus Dilation System

Treatment of Maxillary Sinusitis Using the SinuSys Vent-Os Sinus Dilation System White PAPer Treatment of Maxillary Sinusitis Using the SinuSys Vent-Os Sinus Dilation System Jerome Hester, MD Chief Medical Officer SinuSys Corporation Palo Alto, California USA introduction Establishment

More information

What is Balloon Sinuplasty?

What is Balloon Sinuplasty? What is Balloon Sinuplasty? The painful symptoms associated with chronic sinusitis can be overwhelming. If symptoms are difficult to control with medications alone, your primary doctor may refer you to

More information

Bariatric surgery post operation

Bariatric surgery post operation Bariatric surgery post operation Alireza Khalaj Shahed university Tehran Obesity Treatment Center WWW. TOTC. IR Monthly conference of IAGH 20 August; 2015 OUTLINES Which patients should be offered bariatric

More information

The Arguments: T2DM - tremendous economic burden globally Lifestyle / Pharm Rx:

The Arguments: T2DM - tremendous economic burden globally Lifestyle / Pharm Rx: James Cromie The Arguments: T2DM - tremendous economic burden globally Lifestyle / Pharm Rx: INEFFECTIVE and UNSUSTAINED Bariatric surgery is an Effective and Durable treatment option Well established

More information

Endoscopy and infection: Prevention of infection during endoscopy Treatment of infection by endoscopy. M. Arvanitakis SRBG June 2009

Endoscopy and infection: Prevention of infection during endoscopy Treatment of infection by endoscopy. M. Arvanitakis SRBG June 2009 Endoscopy and infection: Prevention of infection during endoscopy Treatment of infection by endoscopy M. Arvanitakis SRBG June 2009 Outline Antibiotic prophylaxis during endoscopy Upper GI endoscopy Lower

More information

SURGICAL PREAMBLE SPECIFIC ELEMENTS SURGICAL SERVICES WHICH ARE NOT LISTED AS A "Z" CODE

SURGICAL PREAMBLE SPECIFIC ELEMENTS SURGICAL SERVICES WHICH ARE NOT LISTED AS A Z CODE Surgical PreambleApril 1, 2015 PREAMBLE SPECIFIC ELEMENTS In addition to the common elements, all surgical services include the following specific elements. A. Supervising the preparation of and/or preparing

More information

INFORMED CONSENT FOR SLEEVE GASTRECTOMY

INFORMED CONSENT FOR SLEEVE GASTRECTOMY INFORMED CONSENT FOR SLEEVE GASTRECTOMY This informed-consent document has been prepared to help inform you about your Sleeve Gastrectomy including the risks and benefits, as well as alternative treatments.

More information

2016 Physician Quality Reporting System Data Collection Form: General Surgery (for patients aged 18 and older)

2016 Physician Quality Reporting System Data Collection Form: General Surgery (for patients aged 18 and older) 2016 Physician Quality Reporting System Data Collection Form: General Surgery (for patients aged 18 and older) IMPORTANT: Any measure with a 0% performance rate (100% for inverse measures) is not considered

More information

Why a loop and new approach makes sense!

Why a loop and new approach makes sense! IP: tomach Intestinal Pylorus paring urgery Why a loop and new approach makes sense! Mitchell Roslin, MD, FAC Chief of Bariatric and Metabolic urgery Lenox Hill Hospital Northern Westchester Hospital Center

More information

BARIATRIC SURGERY MAY CURE TYPE 2 DIABETES IN SOME PATIENTS

BARIATRIC SURGERY MAY CURE TYPE 2 DIABETES IN SOME PATIENTS BARIATRIC SURGERY MAY CURE TYPE 2 DIABETES IN SOME PATIENTS Thomas Rogula MD, Stacy Brethauer MD, Bipand Chand MD, and Philip Schauer, MD. "Gastric bypass surgery has become a popular option for obese

More information

Colocutaneous Fistula. Disclosures

Colocutaneous Fistula. Disclosures Colocutaneous Fistula Madhulika G. Varma MD Associate Professor Chief, Colorectal Surgery University of California, San Francisco Honoraria Applied Medical Covidien Disclosures 1 Colocutaneous Fistula

More information

Treatment for Severely Obese Patients

Treatment for Severely Obese Patients Treatment for Severely Obese Patients Associate Professor Jimmy So Senior Consultant Surgeon Director, Centre for Obesity Management and Surgery (COMS) National University Hospital Obesity Shortens Lives

More information

Laparoscopic Roux-En-Y Gastric Bypass Versus Laparoscopic Adjustable Gastric Banding in the

Laparoscopic Roux-En-Y Gastric Bypass Versus Laparoscopic Adjustable Gastric Banding in the 553148SJS0010.1177/1457496914553148LRYGB vs LAGB in super-obese patients (BMI >50)S. Giordano, et al. research-article2015 Original Article Scandinavian Journal of Surgery 104: 5 9, 2015 Laparoscopic Roux-En-Y

More information

Laparoscopic Ventral Hernia Repair Patient Information from SAGES

Laparoscopic Ventral Hernia Repair Patient Information from SAGES Laparoscopic Ventral Hernia Repair Patient Information from SAGES Approximately 350,000-500,000 ventral hernia repairs are performed each year in the United States. Many are performed by the conventional

More information

GASTRIC SLEEVE SURGERY FOR WEIGHT LOSS. www.malleysurgical.com GASTRIC SLEEVE SURGERY FOR WEIGHT LOSS

GASTRIC SLEEVE SURGERY FOR WEIGHT LOSS. www.malleysurgical.com GASTRIC SLEEVE SURGERY FOR WEIGHT LOSS GASTRIC SLEEVE SURGERY FOR WEIGHT LOSS www.malleysurgical.com GASTRIC SLEEVE SURGERY FOR WEIGHT LOSS 1 CONTENTS What is sleeve gastrectomy? Why choose sleeve gastrectomy? Health risks associated with excess

More information

Laparoscopic gastric pouch and remnant resection: a novel approach to. refractory anastomotic ulcers after Roux-en-Y Gastric Bypass: Case report

Laparoscopic gastric pouch and remnant resection: a novel approach to. refractory anastomotic ulcers after Roux-en-Y Gastric Bypass: Case report Laparoscopic gastric pouch and remnant resection: a novel approach to refractory anastomotic ulcers after Roux-en-Y Gastric Bypass: Case report Daniel C. Steinemann 1, ; Marc Schiesser 1 ; Pierre-Alain

More information

What is the Sleeve Gastrectomy?

What is the Sleeve Gastrectomy? What is the Sleeve Gastrectomy? The Sleeve Gastrectomy (also referred to as the Gastric Sleeve, Vertical Sleeve Gastrectomy, Partial Gastrectomy, or Tube Gastrectomy) is a relatively new procedure for

More information

GASTRIC SLEEVE SURGERY FOR WEIGHT LOSS. www.carepointhealth.org GASTRIC SLEEVE SURGERY FOR WEIGHT LOSS. 201-795-8175 CarePointHealth.

GASTRIC SLEEVE SURGERY FOR WEIGHT LOSS. www.carepointhealth.org GASTRIC SLEEVE SURGERY FOR WEIGHT LOSS. 201-795-8175 CarePointHealth. www.carepointhealth.org GASTRIC SLEEVE SURGERY FOR WEIGHT LOSS 201-795-8175 CarePointHealth.org 1 CONTENTS What is sleeve gastrectomy? Why choose sleeve gastrectomy? Health risks associated with excess

More information

Diabetes and Weight-Loss Surgery

Diabetes and Weight-Loss Surgery WHITE PAPER Diabetes and Weight-Loss Surgery Treat the cause. Cure the symptom. Center of Excellence BARIATRIC SURGERY Written July 2011 Bariatric Surgery: The Cure for Type II Diabetes? For most individuals

More information

Laparoscopic Sleeve gastrectomy

Laparoscopic Sleeve gastrectomy Restrictive procedure Laparoscopic Sleeve gastrectomy Dr. R. Peterli Professional Education 1 2 Introduction Gastric sleeve resection is the restrictive part of the biliopancreatic diversion duodenal switch,

More information

Teresa LaMasters MD, FACS Minimally Invasive Bariatric Surgeon Iowa Health Weight Loss Specialists Throckmorton Surgical Society May 4, 2012

Teresa LaMasters MD, FACS Minimally Invasive Bariatric Surgeon Iowa Health Weight Loss Specialists Throckmorton Surgical Society May 4, 2012 Laparoscopic Sleeve Gastrectomy Teresa LaMasters MD, FACS Minimally Invasive Bariatric Surgeon Iowa Health Weight Loss Specialists Throckmorton Surgical Society May 4, 2012 Objectives Understand the anatomy

More information

Bariatric Surgery. Beth A. Ryder, MD FACS. Assistant Professor of Surgery The Miriam Hospital Warren Alpert Medical School of Brown University

Bariatric Surgery. Beth A. Ryder, MD FACS. Assistant Professor of Surgery The Miriam Hospital Warren Alpert Medical School of Brown University Bariatric Surgery Beth A. Ryder, MD FACS Assistant Professor of Surgery The Miriam Hospital Warren Alpert Medical School of Brown University April 30, 2013 Why surgery? Eligibility criteria Most commonly

More information

Laparoscopic Adjustable Gastric Banding as a Type of Weight Loss

Laparoscopic Adjustable Gastric Banding as a Type of Weight Loss Laparoscopic Adjustable Gastric Banding as a Type of Weight Loss Abstract Obesity has become a global health crisis. Traditional treatments try to modify behavior in regard to diet and exercise. Laparoscopic

More information

Aaron B. House MD, PGY-5 University of Kentucky Department of General Surgery Grand Rounds October 23, 2013

Aaron B. House MD, PGY-5 University of Kentucky Department of General Surgery Grand Rounds October 23, 2013 Aaron B. House MD, PGY-5 University of Kentucky Department of General Surgery Grand Rounds October 23, 2013 Objectives Briefly illustrate the recent obesity trends in the U.S Give a brief history of bariatric

More information

Bariatric Weight Loss Surgery

Bariatric Weight Loss Surgery BARIATRIC SURGERY Bariatric Weight Loss Surgery The heart and science of medicine. Weight loss surgery, also known as bariatric surgery, was developed as a tool to help people with morbid obesity reduce

More information

HOSPIRA (HSP US) HISTORICAL COMMON STOCK PRICE INFORMATION

HOSPIRA (HSP US) HISTORICAL COMMON STOCK PRICE INFORMATION 30-Apr-2004 28.35 29.00 28.20 28.46 28.55 03-May-2004 28.50 28.70 26.80 27.04 27.21 04-May-2004 26.90 26.99 26.00 26.00 26.38 05-May-2004 26.05 26.69 26.00 26.35 26.34 06-May-2004 26.31 26.35 26.05 26.26

More information

INFORMATION SHEET FOR A LAPAROSCOPIC SLEEVE GASTRECTOMY

INFORMATION SHEET FOR A LAPAROSCOPIC SLEEVE GASTRECTOMY INFORMATION SHEET FOR A LAPAROSCOPIC SLEEVE GASTRECTOMY You are considering undergoing a laparoscopic sleeve gastrectomy for weight loss. The purpose of this information sheet is to provide you with the

More information

Chronic Fistula After Revision Laparoscopic Sleeve Gastrectomy

Chronic Fistula After Revision Laparoscopic Sleeve Gastrectomy CASE REPORT Chronic Fistula After Revision Laparoscopic Sleeve Gastrectomy Giuseppe S. Sica, MD, PhD, Marco D Eletto, MD, Cristina Fiorani, MD, Andrea Divizia, MD, Paolo Gentileschi, MD, Domenico Benavoli,

More information

Valk J.W., Gypen B., Abdelgabar A., Hendrickx L. Schijns W., Aarts E., Janssen I., Berends F. Rheinwalt K.P., Schneider S., Plamper A.

Valk J.W., Gypen B., Abdelgabar A., Hendrickx L. Schijns W., Aarts E., Janssen I., Berends F. Rheinwalt K.P., Schneider S., Plamper A. Revisional Surgery for Weight Regain or Insufficient Weight Loss after Gastric Bypass using the Minimizer Ring: Short Term Results of a Multi Center Study Valk J.W., Gypen B., Abdelgabar A., Hendrickx

More information

MH. Huang Show Chwan Memorial Hospital Changhua, Taïwan

MH. Huang Show Chwan Memorial Hospital Changhua, Taïwan PROGRAM ENDOLUMIINAL AND LAPAROSCOPIIC BARIIATRIIC AND METABOLIIC SURGERY COURSE SEPTEMBER 10 12,, 2015 CHHAAIIRRMMAANN MH. Huang Show Chwan Memorial Hospital Changhua, Taïwan PPRREESSIIDDEENNTT SSUUPPEERRIINNTTEENNDDEENNTT

More information

Lose the Weight, Find your Life

Lose the Weight, Find your Life Bariatric Surgery: University of Iowa Lose the Weight, Find your Life Isaac Samuel, MD, FRCS, FACS Professor of Surgery Director, Bariatric Surgery 1 Present UI Bariatric Surgeons Jessica Smith, MD Peter

More information

M O V I N G F R E E LY. HerniaCenter. The Columbia Hernia Center at ColumbiaDoctors Midtown

M O V I N G F R E E LY. HerniaCenter. The Columbia Hernia Center at ColumbiaDoctors Midtown M O V I N G F R E E LY HerniaCenter The Columbia Hernia Center at ColumbiaDoctors Midtown Director, Dr. Peter L. Geller The Columbia Hernia Center brings together a group of surgeons adept in using the

More information

The Evolution of Bariatric Surgery. History of the Development of a Successful Bariatric Program at the University of Iowa Hospitals & Clinics

The Evolution of Bariatric Surgery. History of the Development of a Successful Bariatric Program at the University of Iowa Hospitals & Clinics The Evolution of Bariatric Surgery History of the Development of a Successful Bariatric Program at the University of Iowa Hospitals & Clinics It s a BIG Problem & it s Getting Worse Obesity is now a disease

More information

Facing a Hysterectomy? If you ve been diagnosed with early stage gynecologic cancer, learn about minimally invasive da Vinci Surgery

Facing a Hysterectomy? If you ve been diagnosed with early stage gynecologic cancer, learn about minimally invasive da Vinci Surgery Facing a Hysterectomy? If you ve been diagnosed with early stage gynecologic cancer, learn about minimally invasive da Vinci Surgery The Condition: Early Stage Gynecologic Cancer A variety of gynecologic

More information

YALE UNIVERSITY SCHOOL OF MEDICINE: SECTION OF OTOLARYNGOLOGY PATIENT INFORMATION FUNCTIONAL ENDOSCOPIC SINUS SURGERY

YALE UNIVERSITY SCHOOL OF MEDICINE: SECTION OF OTOLARYNGOLOGY PATIENT INFORMATION FUNCTIONAL ENDOSCOPIC SINUS SURGERY YALE UNIVERSITY SCHOOL OF MEDICINE: SECTION OF OTOLARYNGOLOGY PATIENT INFORMATION FUNCTIONAL ENDOSCOPIC SINUS SURGERY What is functional endoscopic sinus surgery (FESS)? Functional endoscopic sinus surgery

More information

Gastrobronchial fistula after sleeve gastrectomy and gastric bypass: endoscopic management and prevention

Gastrobronchial fistula after sleeve gastrectomy and gastric bypass: endoscopic management and prevention DOI 10.1007/s11695-011-0444-8 CLINICAL REPORT Gastrobronchial fistula after sleeve gastrectomy and gastric bypass: endoscopic management and prevention Josemberg Marins Campos & Eduardo Franca Pereira

More information

9/26/14. Joel E. Rand, MPAS, PA-C DMU Luncheon May 1, 2014

9/26/14. Joel E. Rand, MPAS, PA-C DMU Luncheon May 1, 2014 Joel E. Rand, MPAS, PA-C DMU Luncheon May 1, 2014 No financial relationship or commercial interest in any of the technologies discussed Not supporting any non-fda off label uses of any product or service

More information

Resection, Reduction, and Revision of Aneurysmal AV Fistulas

Resection, Reduction, and Revision of Aneurysmal AV Fistulas Resection, Reduction, and Revision of Aneurysmal AV Fistulas Patrick R. Cook DO, FACS Timothy G. Canty Jr. MD Robert J. Hye MD, FACS Kaiser Permanente San Diego, CA Aneurysmal AVF Over last decade K-DOQI

More information

Complications of pediatric endoscopy and colonoscopy. Informed consent. Learning objectives. Complication types. Complications (adults) 10/3/2012

Complications of pediatric endoscopy and colonoscopy. Informed consent. Learning objectives. Complication types. Complications (adults) 10/3/2012 Complications of pediatric endoscopy and colonoscopy I have no financial relationships with any commercial entity to disclose Petar Mamula, M.D. The Children s Hospital of Philadelphia University of Pennsylvania

More information