Division of Minimally Invasive Gynecologic Surgery (Drs Kliethermes, Blazek, Rezai, and Dr Guan) and Division of Maternal Fetal Medicine (Dr Fox), Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA. Guangzhou Medical University, Guangzhou Shi, China (Mr Guan, Dr Guan).

ABSTRACT

Introduction: Preterm labor and cervical insufficiency are significant health problems in obstetrics. They can lead to devastating outcomes for families and significant costs. Cervical and abdominal cerclages can improve outcomes in appropriately selected patients.

Case Report: This is a case of a 31-year-old woman (Gravida 8, Para 1-2-4-1) who presented at 11 weeks with a diamniotic–dichorionic twin gestation. A laparoscopic abdominal cerclage was placed and she successfully carried her pregnancy to 35 weeks, when she was delivered for obstetric indications.

Discussion: Despite convincing literature suggesting increased morbidity with cerclage placement in twin gestations, in properly selected patients, a cerclage may in fact be beneficial. Growing evidence has shown effectiveness of laparo- scopically placed cerclages, and should be considered an alternative to laparotomy. Laparoscopic abdominal cerclage can safely be performed for twin gestation. Multispecialty approach can improve outcomes and increase safety. Gentle tissue handling is important in all laparoscopic surgery, but especially during pregnancy.

Key Words: Abdominal cerclage, Laparoscopic cerclage, Twin pregnancy.

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Department of General Surgery, Easton Hospital, Easton, PA, USA (Drs. Baccaro, Ogu, Ibrahim, and Kohli). Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA (Dr. Vunnamadala).

ABSTRACT

Introduction: Morbid obesity is an growing problem in the United States. As the incidence of morbid obesity increases, so does the number of surgical procedures for weight loss. Surgeons must learn to manage common complications of these procedures.

Case Descriptions and Operative Technique: We present two cases of massive upper gastrointestinal hemorrhage secondary to marginal ulcers eroding into the left gastric artery. A novel surgical technique has been described from these experiences to deal quickly with this highly fatal complication.

Discussion: General surgeons must be aware of the altered anatomy and physiology because they will encounter these patients in the emergency setting. It is important to be familiar with common complications, know how to identify them in a timely manner, and treat them accordingly. Marginal ulcers are frequent; however, torrential hemorrhage secondary to these is less common and extremely lethal.

Key Words: Laparoscopic Roux-en-Y gastric bypass, Marginal ulcer after gastric bypass, Gastrointestinal bleeding, Surgical technique, Emergency surgery.

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