Bariatric surgery - JSLS

Transforming Lives: A Gastric Bypass That Enabled a Gender Confirmation

SLS — Thu, 07 Mar 2019 19:21:50 +0000

Matthew Wynn, MD, Benjamin Clapp, MD

Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, El Paso, TX, USA (Drs Wynn and Clapp)

ABSTRACT

Background: In the past, hormonal therapy was the primary treatment option for patients with gender dysphoria, but it has been supplemented in recent years by surgical treatments, termed sex reassignment surgery (SRS).

Case Report: A 41-year-old male-to-female patient presented with morbid obesity, hypertension, hyperlipidemia, obstructive sleep apnea, fibromyalgia, and osteoarthritis. She identified as a woman and planned to undergo gender confirmation surgery. She had already undergone bilateral orchiectomies and was enrolled in hormonal therapy. The patient underwent a laparoscopic Roux-en-Y gastric bypass without complication. At 1 year postoperation, the patient has experienced a 65% extra body weight loss, her body dissatisfaction has resolved, and she has undergone bilateral breast augmentation. She is now planning to finish her transition.

Discussion: This patient highlights an important consequence of weight loss surgery in an underserved segment of society that suffers from morbid obesity as well as gender identity issues. One study from 2016 found that up to 61% of the lesbian, gay, bisexual and transgender (LGBT) respondents were obese or overweight, and transgender individuals had the highest prevalence of obesity among the different groups of the LGBT community. With government insurances now funding SRS surgeries, bariatric surgeons will likely encounter patients undergoing gender confirmation surgeries more often.

Conclusions: Bariatric surgery can assist transgender patients with confirming their gender, without the risks associated with primary eating disorders. The transgender population remains an underserved sector of the morbidly obese population, and bariatric surgeons are more likely to see patients undergoing gender confirmation surgery.

Key Words: Bariatric Surgery, Gender Confirmation, Gastric Bypass.

[gview file=”https://crsls.sls.org/wp-content/uploads/2019/03/jls101193764001.pdf”]

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Acute Gastric Dilatation Following 360-Degree Erosion of Gastric Lap Band

SLS — Thu, 13 Sep 2018 21:22:34 +0000

Jane E. Harrell, BS, Jeffrey Friedman, MD

College of Medicine (Dr Harrell) and Department of Surgery (Dr Friedman), University of Florida, Gainesville, Florida, USA.

ABSTRACT

Introduction: Gastric band erosion is a rare but serious complication after laparoscopic adjustable gastric band placement. With this complication, the band usually partially erodes into the stomach lumen, which necessitates its removal. We present 2 previously unreported cases of complete 360° erosion with acute gastric dilatation, requiring emergent removal of the eroded band.

Case Descriptions: A 51-year-old woman with a 7-year history of laparoscopic adjustable gastric band presented to the emergency department with epigastric abdominal pain, nausea, vomiting, and dysphagia. Computed tomography (CT) revealed gastric dilatation below the eroded band, and intraoperative endoscopy confirmed that the band had completely eroded into the lumen. A 76-year-old man with an 8-year history of gastric band developed acute-onset nausea and severe abdominal pain. CT revealed 360° erosion of the band with severe gastric dilatation below the eroded band, causing gastric pneumatosis and hepatic portal venous gas. Management of both cases involved removal of the gastric band through a gastrotomy.

Discussion: Gastric band erosion of 360° with concurrent acute gastric dilatation requires immediate removal of the eroded band, to prevent the severe complication of gastric necrosis.

Key Words: Bariatric surgery, Erosion of lap band, Lap band, Lap band complications.

[gview file=”https://crsls.sls.org/wp-content/uploads/2018/09/jls102183691001.pdf”]

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Abdominal Catastrophe During Pregnancy Due to a Gastric Band

SLS — Sat, 15 Nov 2014 04:40:54 +0000

Gurdeep S. Matharoo, MD, Samir R. Shah, MD, Steven J. Binenbaum, MD, Frank J. Borao, MD

Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA (all authors).

ABSTRACT

Introduction: Laparoscopic adjustable gastric banding is popular bariatric procedure for patients with morbid obesity. The procedure is appealing to patients and surgeons because of its customizable approach to weight loss. The rate of complications after laparoscopic adjustable gastric banding has been reported to be up to 12.2%. Without a high degree of suspicion, the complications can go unrecognized until they have progressed to a catastrophic state.

Case Description: We present a 32-year-old pregnant woman, with a history of laparoscopic adjustable gastric banding, who presented with complaints of persistent nausea and vomiting causing significant weight loss. She was treated with intravenous hydration and antiemetic medication. After 3 days of in-hospital treatment, she was discharged home after resolution of symptoms. She then returned to the hospital with severe abdominal pain. The fetal heart tones were lost, and she delivered a stillborn fetus. Radiologic testing suggested abdominal hollow organ perforation, and the patient was taken to the operating room. Diagnostic laparoscopy discovered a prolapsed gastric band causing obstruction and an anterior gastric perforation proximal to the band. The perforation was repaired primarily, and an omental patch was used as a buttress.

Conclusion: Although nausea and vomiting are common symptoms during pregnancy, their cause must be fully investigated in bariatric patients. The complications in bariatric patients can be catastrophic if not recognized and treated appropriately. As weight loss surgery increases in popularity and age limits are decreased, more women of childbearing age will present after bariatric procedures, and all complications must be ruled out.

Key Words: Laparoscopic adjustable gastric banding, LAGB, Pregnancy, Bariatric surgery, Hyperemesis gravidarum, Abdominal catastrophe.[gview file=”https://crsls.sls.org/wp-content/uploads/2014/11/13-00174.pdf”]

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Laparoscopic Approach to Barrett Carcinoma in an Obese Patient

SLS — Sat, 15 Nov 2014 03:20:17 +0000

Georg Wiltberger, MD, Felix Krenzien, MD, Hans-Michael Hau, MD, Hans-Michael Tautenhahn,

Albrecht Hoffmeister, MD, Sven Jonas, MD, Arne Dietrich, MD

Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany (Drs. Wiltberger, Krenzien, Hau, Tautenhahn, Jonas, Dietrich).

Department of Medicine, Dermatology and Neurology, Division of Gastroenterology and Rheumatology, University of Leipzig, Leipzig, Germany (Dr. Hoffmeister)ABSTRACT

We report an obese patient who was initially scheduled for laparoscopic Roux-en-Y gastric bypass, but who was subsequently diagnosed preoperatively with Barrett carcinoma. After incomplete endoscopic mucosectomy, laparoscopic oncologic resection (transhiatal extended cardia resection) combined with bariatric reconstruction was performed. Sufficient complication management of a small anastomotic leak into the right pleural space was maintained with a combination of video-assisted thoracoscopy and endoscopic clipping of the leak.

Key Words: Barrett carcinoma, Bariatric surgery, LRYGB, Merendino[gview file=”https://crsls.sls.org/wp-content/uploads/2014/11/13-00132.pdf”]

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