Laparoscopic conversion of vertical banded gastroplasty with an antireflux wrap into Roux-en-Y gastric bypass

BACKGROUND

Vertical banded gastroplasty (VBG) is associated with a significant rate of revision because of regain of weight due to staple-line disruption, gastric pouch and stoma dilation, change to sweet eating, outlet stenosis with vomiting and reflux. To avoid reflux, some surgeons added an antireflux wrap.

METHODS

We report laparoscopic revision of VBG with antireflux wrap to Roux-en-Y gastric bypass (RYGBP) in 4 patients. The indication for revision was insufficient weight loss in all 4 patients, with stenosis of the stoma resistant to endoscopic balloon dilation in one and reflux esophagitis in one, who shifted to high-calorie liquids. Revision was performed 73.5 months (range 57-84) after the primary procedure, at mean BMI 39.5 (range 37-41).

RESULTS

Mean operative time was 193.7 min (165-220). There was no conversion to open surgery. There was no mortality. One patient developed a stenosis at the gastrojejunostomy that was managed successfully with endoscopic balloon dilation. Mean length of stay was 6.8 days (range 4-9). At mean follow-up of 11.2 months (range 11-18), mean BMI is 28.5 (range 27-30), and all patients were free of co-morbidities.

CONCLUSIONS

Laparoscopic revision of VBG with an antireflux wrap into an LRYGBP is feasible and effective in achieving weight loss, but the safety requires assessment by a larger series.

Torsion of a uterine leiomyoma: MRI features

We report a case of a patient admitted to our hospital for acute pelvic pain. Ultrasounds and abdominal CT scan found a voluminous mass situated in the upper urinary bladder and contiguous to the uterus and to the ovaries. Magnetic resonance imaging identified a pedicle connecting the uterus to the mass which had an aspect of a necrobiotic leiomyoma. Laparoscopic surgery confirmed the diagnosis of acute torsion of a subserous uterine leiomyoma.

Atypical MRI features of a biliary cystadenoma revealed by jaundice

We report on the case of a patient admitted for epigastric pain. An abdominal ultrasound revealed a voluminous cystic lesion of the left hepatic lobe. In magnetic resonance imaging, the mass had a liquid-liquid level that was spontaneously hyperintense on T(1)-weighted images and hypointense on T(2)-weighted images. Magnetic resonance cholangiography identified bilateral intrahepatic bile duct dilatation. A left hepatectomy finally revealed a mucinous cystadenoma with pseudo-ovarian stroma that had a pedunculated intraductal extension to the biliary convergence.