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https://www.readbyqxmd.com/read/28902968/two-step-eus-guided-antegrade-treatment-of-a-difficult-bile-duct-stone-in-a-surgically-altered-anatomy-patient
#1
Yousuke Nakai, Hiroyuki Isayama, Kazuhiko Koike
EUS-guided antegrade (EUS-AG) treatment is a treatment option for bile duct stones (BDS) in surgically altered anatomy patients[1, 2] but can be technically demanding due to the limitation of stone extraction devices[3, 4]. Herein, we presented a case of a difficult BDS successfully removed by two-step EUS-AG treatment after enterobiliary fistula maturation.A 73 year-old male with a history of gastrectomy and Roux-en-Y reconstruction for gastric cancer presented with 12-mm BDS on CT scan (Figure1). This article is protected by copyright...
September 13, 2017: Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society
https://www.readbyqxmd.com/read/28890311/pancreatoduodenectomy-after-roux-en-y-gastric-bypass-technical-considerations-and-outcomes
#2
June S Peng, Ricard Corcelles, Kevin Choong, Matthew Poturalski, Namita Gandhi, R Matthew Walsh, Jeffrey M Hardacre, Stacy A Brethauer, Gareth Morris-Stiff
BACKGROUND: Patients with altered anatomy due to Roux-en-Y gastric bypass (RYGB) present unique diagnostic and therapeutic challenges when they present with periampullary pathology. We describe a series of patients who underwent pancreatoduodenectomy (PD) after gastric surgery with Roux-en-Y reconstruction and review the literature to highlight technical considerations and outcomes. METHODS: Patients from two institutions were identified and data regarding preoperative workup, operative conduct, and pathologic and clinical outcomes were collected...
September 7, 2017: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
https://www.readbyqxmd.com/read/28873388/gastrointestinal-endocrinology-in-bariatric-surgery
#3
Martin Wabitsch
The long-lasting weight-reducing effect of bariatric surgical procedures cannot simply be explained by the malabsorption of nutrients and the subsequent energy deficit due to this malabsorption. Clinical studies have shown that the reorganization of the anatomy of the gut and the subsequent alterations of gastrointestinal physiology have a large impact on the secretion and function of gastrointestinal hormones, which regulate hunger and satiety. These changes have been named the BRAVE effect: <under>b</under>ile flow alteration, <under>r</under>eduction of gastric size, <under>a</under>natomical gut rearrangement and altered flow of nutrients, <under>v</under>agal manipulation, and <under>e</under>nteric gut modulation...
2017: Endocrine Development
https://www.readbyqxmd.com/read/28872684/new-perspectives-on-the-development-of-extrahepatic-portosystemic-shunts
#4
REVIEW
R N White, C Shales, A T Parry
In this essay we use clinical evidence and knowledge of anatomy to examine the relationship between blood flow and formation of congenital extrahepatic portosystemic shunts in dogs and cats. First we report on the clinical findings in a series of 50 dogs and 10 cats and then systematically review peer-reviewed data on the detailed anatomy of shunts in dogs and cats. In dogs four types of shunt: spleno-caval, left gastro-phrenic, left gastro-azygos and those involving the right gastric vein account for 94% of extrahepatic shunts...
September 5, 2017: Journal of Small Animal Practice
https://www.readbyqxmd.com/read/28868226/recurrent-gastric-ulcer-and-cholangitis-caused-by-ectopic-drainage-of-the-bile-duct-into-the-stomach
#5
Katrin Bauer, Christof Keller
We report a case of recurrent gastritis with pyloric stenosis and cholangitis due to a rare variation in bile duct anatomy. A 72-year-old female patient showed recurrent gastral ulcers and biliary colic with cholangitis caused by gallstones in the main bile duct with an ectopic orifice in the prepyloric region and concurrent inflammatory pyloric stenosis. After temporarily successful endoscopic treatment with stenting and pyloric dilatation, the patient suffered from recurrent cholangitis. Finally, the abnormal biliary anatomy required surgical treatment with biliodigestive anastomosis...
2017: GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW
https://www.readbyqxmd.com/read/28836242/-discussion-on-standardized-implementation-of-laparoscopic-radical-lymphadenectomy-for-distal-gastric-cancer
#6
Zejian Lyu, Junjiang Wang, Yong Li
Laparoscopic radical gastrectomy for gastric cancer has been widely applied in clinical practice, and its indications have been extended from early gastric cancer to advanced gastric cancer. It is acknowledged that laparoscopic radical gastrectomy is technically challenging because of the complexity of anatomy, rich blood supply, and extensive lymph node dissection. This paper primarily intends to share the experience of laparoscopic radical D2 gastrectomy for distal gastric cancer with details of choosing the location of Trocar, surgical approaches and the sequence of lymph node dissection...
August 25, 2017: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
https://www.readbyqxmd.com/read/28836239/-reconsideration-of-hot-topics-on-laparoscopic-radical-gastrectomy
#7
Lu Zang, Junjun Ma, Minhua Zheng
Laparoscopic radical gastrectomy(LRG) has been popularized with the development of laparoscopic surgical techniques. As a result of the requirement of surgical skill of LRG, the evidence is always highly demanded. The surgical safety and radical resection of tumor is one of the most important principles. Based on published studies and authors' own experience, this article discusses the following topics on laparoscopic gastrectomy: (1)Indications of surgery: Laparoscopic gastrectomy for early gastric cancer is accepted all over the world...
August 25, 2017: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
https://www.readbyqxmd.com/read/28803414/laparoscopic-reversal-of-mini-gastric-bypass-to-original-anatomy-for-severe-postoperative-malnutrition
#8
Laurent Genser, Antoine Soprani, Malek Tabbara, Jean-Michel Siksik, Jean Cady, Sergio Carandina
PURPOSE: Malnutrition after mini-gastric bypass (MGB) is a rare and dreaded complication with few data available regarding its surgical management. We aim to report the feasibility, safety, and results of laparoscopic reversal of MGB to normal anatomy (RMGB) in case of severe and refractory malnutrition syndrome after intensive nutritional support (SRMS). METHODS: A 10-year retrospective chart review was performed on patients who underwent RMGB (video included) for SRMS following MGB...
August 12, 2017: Langenbeck's Archives of Surgery
https://www.readbyqxmd.com/read/28796602/contrast-enhanced-magnetic-resonance-imaging-of-gastric-emptying-and-motility-in-rats
#9
Kun-Han Lu, Jiayue Cao, Steven Oleson, Terry L Powley, Zhongming Liu
The assessment of gastric emptying and motility in humans and animals typically requires radioactive imaging or invasive measurements. Here, we developed a robust strategy to image and characterize gastric emptying and motility in rats based on contrast-enhanced magnetic resonance imaging (MRI) and computer-assisted image processing. The animals were trained to naturally consume a gadolinium-labeled dietgel while bypassing any need for oral gavage. Following this test meal, the animals were scanned under low-dose anesthesia for high-resolution T1-weighted MRI in 7-Tesla, visualizing the time-varying distribution of the meal with greatly enhanced contrast against non-GI tissues...
August 8, 2017: IEEE Transactions on Bio-medical Engineering
https://www.readbyqxmd.com/read/28771242/pancreatic-and-intestinal-function-post-roux-en-y-gastric-bypass-surgery-for-obesity
#10
Stephen J D O'Keefe, Tina Rakitt, Junhai Ou, Ihab I El Hajj, Elizabeth Blaney, Kishore Vipperla, Jens-Jules Holst, Jens Rehlfeld
OBJECTIVES: Despite the fact that the most effective treatment for morbid obesity today is gastric bypass surgery, some patients develop life-threatening nutritional complications associated with their weight loss. METHODS: Here we examine the influence of the altered anatomy and digestive physiology on pancreatic secretion and fat absorption. Thirteen post Roux-en-Y gastric bypass (RYGB) patients who had lost >100 lbs in the first year following surgery and who gave variable histories of gastrointestinal (GI) dysfunction, were selected for study...
August 3, 2017: Clinical and Translational Gastroenterology
https://www.readbyqxmd.com/read/28765690/diarrhea-after-bariatric-procedures-diagnosis-and-therapy
#11
REVIEW
Yves M Borbély, Alice Osterwalder, Dino Kröll, Philipp C Nett, Roman A Inglin
Diarrhea after bariatric procedures, mainly those with malabsorptive elements including Roux-Y Gastric Bypass and Biliopancreatic Diversion, is common and an essential determinant of quality of life and micro- and macronutrient deficiencies. Bariatric surgery is the only sustainably successful method to address morbid obesity and its comorbidities, particularly gaining more and more importance in the specific treatment of diabetic patients. Approximately half a million procedures are annually performed around the world, with numbers expected to rise drastically in the near future...
July 14, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28681283/the-visualization-of-gastro-esophageal-junction-vascular-supply-during-a-laparoscopic-sleeve-gastrectomy-role-of-a-new-device
#12
Mario Musella, Marco Milone, Paolo Bianco, Francesco Milone
Leaks arising at the level of gastro-esophageal junction remain a major complication in patients who undergo a laparoscopic sleeve gastrectomy. Besides technical pitfalls, these fistulas are mainly attributable to tissue ischemia following the preparation of the gastric sleeve, explained by the irregular vascularization often present in the area of the gastro-esophageal junction. This video presentation shows how, the utilization of a new model of bougie can be of help in preventing a leak, allowing a better visualization of the particular vascular anatomy present at the level of the gastro-esophageal junction area...
July 5, 2017: Updates in Surgery
https://www.readbyqxmd.com/read/28680719/real-time-vessel-navigation-using-indocyanine-green-fluorescence-during-robotic-or-laparoscopic-gastrectomy-for-gastric-cancer
#13
Mina Kim, Sang-Yong Son, Long-Hai Cui, Ho-Jung Shin, Hoon Hur, Sang-Uk Han
PURPOSE: Identification of the infrapyloric artery (IPA) type is a key component of pylorus-preserving gastrectomy. As the indocyanine green (ICG) fluorescence technique is known to help visualize blood vessels and flow during reconstruction, we speculated that this emerging technique would be helpful in identifying the IPA type. MATERIALS AND METHODS: From August 2015 to February 2016, 20 patients who underwent robotic or laparoscopic gastrectomy were prospectively enrolled...
June 2017: Journal of Gastric Cancer
https://www.readbyqxmd.com/read/28652536/the-important-role-of-ghrelin-on-gastric-contraction-in-suncus-murinus
#14
Shota Takemi, Ichiro Sakata, Kayuri Kuroda, Yuki Miyano, Anupon Mondal, Takafumi Sakai
Ghrelin, a peptide hormone produced in the stomach, has been known to be involved in the regulation of gastric contraction in humans and rodents. To elucidate the detailed mechanisms of ghrelin on gastric contractions, we used Suncus murinus, a recently established small animal model for gastrointestinal motility. S. murinus produces motilin, a family peptide of ghrelin, and its stomach anatomy and physiological patterns of gastric contractions, in fed and fasted states, are closely similar to humans. Ghrelin administration in phase II, and latter half of phase I, of the migrating motor contractions (MMC) enhanced gastric motility in S...
2017: Endocrine Journal
https://www.readbyqxmd.com/read/28639036/customization-of-laparoscopic-gastric-devascularization-and-splenectomy-for-gastric-varices-based-on-ct-vascular-anatomy
#15
Hirofumi Kawanaka, Tomohiko Akahoshi, Yoshihiro Nagao, Nao Kinjo, Daisuke Yoshida, Yoshihiro Matsumoto, Norifumi Harimoto, Shinji Itoh, Tomoharu Yoshizumi, Yoshihiko Maehara
BACKGROUND: Laparoscopic gastric devascularization(Lap GDS) and splenectomy (SPL) for gastric varices is technically challenging because of highly developed collateral vessels and bleeding tendency. We investigated the feasibility of customization of Lap GDS and SPL based on CT vascular anatomy. METHODS: We analyzed 61 cirrhotic patients with gastric varices who underwent Lap GDS and SPL between 2006 and 2014. Lap GDS was customized according to the afferent feeding veins (left gastric vein (LGV) and/or posterior gastric vein (PGV)/short gastric vein (SGV)) and efferent drainage veins (gastrorenal shunt and/or gastrophrenic shunt, or numerous retroperitoneal veins) based on CT imaging...
June 21, 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/28634319/common-hepatic-artery-quadrifurcation-associated-with-right-hepatic-artery-from-superior-mesenteric-artery-during-laparoscopic-total-splenopancreasectomy
#16
Francesco Caruso, Giorgio Alessandri, Francesca Ciccarese, Giovanni Cesana, Matteo Uccelli, Giorgio Castello, Roberta Villa, Stefano Olmi
Hepatobiliopancreatic surgery is challenging becouse of the complexity of resections and reconstructions and variability of vascular anatomy. The arterial vascularization of the liver is susteined by the common hepatic artery (CHA) that originates from the celiac trunk (CT). The CHA bifurcates into the gastroduodenal artery (GDA) and proper hepatic artery (PHA) 0.5-1 cm medial to the common bile duct (CBD), and the PHA bifurcates into a right and a left branch at hepatic hilum. The most frequent variants are the right hepatic artery (RHA) from the superior mesenteric artery (SMA), the left hepatic artery (LHA) from the left gastric artery (LGA) or a combination of these two variants...
June 12, 2017: Annali Italiani di Chirurgia
https://www.readbyqxmd.com/read/28631148/early-postoperative-imaging-after-non-bariatric-gastric-resection-a-primer-for-radiologists
#17
REVIEW
Massimo Tonolini, Elena Bracchi
Surgical resection represents the mainstay treatment and only potentially curative option for gastric carcinoma, and is increasingly performed laparoscopically. Furthermore, other tumours and selected cases of non-malignant disorders of the stomach may require partial or total gastrectomy. Often performed in elderly patients, gastric resection remains a challenging procedure, with significant morbidity (14-43% complication rate) and non-negligible postoperative mortality (approximately 3%). This paper provides an overview of contemporary surgical techniques for non-bariatric gastric resection, reviews and illustrates the expected postoperative imaging appearances, common and unusual complications after partial and total gastrectomy...
August 2017: Insights Into Imaging
https://www.readbyqxmd.com/read/28625308/the-role-of-ultrasonography-in-obstetric-anesthesia
#18
REVIEW
Allison Lee, John P R Loughrey
Ultrasonography is increasingly being viewed as an everyday tool in obstetric anesthesia. For the administration of spinal or epidural anesthesia, it reduces needle redirection attempts in patients with difficult anatomy. In the less frequent scenario of a collapsed patient, it helps with assessment in the form of transthoracic echocardiography. Abdominal blocks require ultrasound guidance for safe and anatomically correct placement. Accurate assessment of gastric volume status with ultrasound would be a useful everyday skill if it is adopted into mainstream practice...
March 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/28624053/radiologic-evaluation-of-vasculobiliary-anatomy-in-the-umbilical-fissure
#19
Gu-Wei Ji, Fei-Peng Zhu, Ke Wang, Yong-Xiang Xia, Chen-Yu Jiao, Zi-Cheng Shao, Xiang-Cheng Li
BACKGROUND: Preoperative evaluation of vasculobiliary anatomy in the umbilical fissure (U-point) is pivotal for perihilar cholangiocarcinoma (PCCA) applied to right-sided hepatectomy. The purpose of our study was to review the vasculobiliary anatomy in the U-point using three-dimensional (3D) reconstruction technique, to investigate the diagnostic ability of 2D scans to evaluate anatomic variations, and to discuss its surgical implications. METHODS: A retrospective study of 159 patients with Bismuth type I, II, and IIIa PCCA, who received surgery at our institution from November 2012 to September 2016, was conducted...
June 15, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28621295/efficacy-and-safety-in-case-of-technical-success-of-endoscopic-ultrasound-guided-transhepatic-antegrade-biliary-drainage-a-report-of-a-monocentric-study
#20
Sébastien Godat, Erwan Bories, Fabrice Caillol, Christian Pesenti, Jean Philippe Ratone, Chiara de Cassan, Marc Giovannini
BACKGROUND AND OBJECTIVES: Endoscopic ultrasound (EUS)-guided biliary drainage techniques are alternative procedures in cases of obstructive jaundice with altered anatomy or failed ERCP. Complications related to EUS-guided antegrade drainage (EUS-AD) are still present in up to 10% of cases, and combination of procedures is sometimes suggested to avoid adverse events. The purpose of our study is to evaluate the efficacy and safety of EUS-AD with transhepatic access in case of technical success...
May 2017: Endoscopic Ultrasound
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