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Abstract: RACIONAL: Bypass gástrico em Y-de-Roux é a opera o bariátrica mais comumente realizada. Pequena bolsa gástrica é criada, deixando uma anastomose gastrojejunal estreita, com uma al a jejunal mais comprida. Muito pouco é conhecido sobre o comportamento desta bolsa em anos após o procedimento. OBJETIVO: Determinar através de estudos prospectivos endoscópico e histológico seqüenciais o tamanho da bolsa gástrica, o diametro da anastomose e o comportamento da infec o por H. pylori após a opera o. MéTODOS: Em 130 pacientes submetidos ao bypass gástrico foram realizadas várias avalia es sequenciais endoscópica (até 120 meses) e histológica de rotina da bolsa gástrica. RESULTADOS: Após a opera o, foram realizadas em média 3,6 endoscopias por paciente. Macroscopicamente quase 95% das pequenas bolsas gástricas eram normais, e o principal achado patológico foi uma úlcera marginal. Esofagite erosiva desapareceu em 93% dos pacientes. N o houve aumento no tamanho orocaudal da bolsa durante o período de observa o. N o houve dilata o do diametro da anastomose gastrojejunal. Perto de 54% de todos os pacientes tinham mucosa fúndica normal, enquanto 18% tinham gastrite cr nica ativa, coincidente com a infec o por H. pylori. Cinco pacientes tinham metaplasia intestinal. CONCLUS O: Com base nesta avalia o endoscópica sequencial, n o houve aumento no tamanho orocaudal da bolsa gástrica, nem do diametro da anastomose gastrojejunal. O comportamento do H. pylori foi inconsistente e difícil de interpretar. BACKGROUND: Roux-en-Y gastric bypass is the most common performed bariatric surgery. A small gastric pouch is created, leaving a narrow gastrojejunal anastomosis, with a long jejunal limb. Very little is known regarding the behavior of this pouch years after surgery. AIM: To determine through prospective sequential endoscopic studies the size of the gastric pouch, the diameter of the anastomosis, and the behavior of H. pylori infection after surgery. METHODS: In 130 patients subjected to resectional gastric bypass, several routine sequential endoscopic (until 120 months) and histological evaluations of the gastric pouch were performed. RESULTS: After surgery, a mean of 3.6 endoscopies/patient were performed. Macroscopically nearly 95% of the small gastric pouches were normal, and the main pathological finding was a marginal ulcer. Erosive esophagitis disappeared in 93% of the patients. There was no increase in the orocaudal size of the pouch during this period of observation. There was no dilatation of the diameter of gastrojejunal anastomosis. Near 54% of all patients

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Stenosis in gastric bypass: Endoscopic management
Jesús Espinel,Eugenia Pinedo
World Journal of Gastrointestinal Endoscopy , 2012, DOI: 10.4253/wjge.v4.i7.290

Abstract: Gastric bypass is a treatment option for morbid obesity. Stenosis of the gastrojejunal anastomosis is a recognized complication. The pathophysiological mechanisms involved in the formation of stenosis are not well known. Gastrojejunal strictures can be classified based on time of onset, mechanism of formation, and endoscopic aspect. Diagnosis is usually obtained by endoscopy. The two main treatment alternatives for stomal stricture are: endoscopic dilatation (balloon or bouginage) and surgical revision (open or laparoscopic). Both techniques of dilation [through-the-scope (TTS) balloon dilators, Bougienage dilators] are considered safe, effective, and do not require hospitalization. The optimal technique for dilation of stomal strictures remains to be determined, but many authors prefer the use of TTS balloon catheters. Most patients can be successfully treated with 1 or 2 sessions. The need for reconstructive surgery of a stomal stricture is extremely rare.

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Multi-bypass with the use of lumen-apposing metal stents to maintain luminal continuity of the GI tract in a patient with altered anatomy
- , 2019, DOI: 10.1016/j.vgie.2019.03.006

Abstract:

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Migrated esophageal stent retrieved via oral double-balloon enteroscopy
- , 2017, DOI: 10.1016/j.vgie.2016.12.010

Abstract:

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Comparison Study between Extracorporeal and Intracorporeal Anastomosis for Laparoscopic Right Hemicolectomy [PDF]
Badawy M. Ahmed, Ebrahim Aboeleuon, Ahmed Soliman
Journal of Cancer Therapy (JCT) , 2019, DOI: 10.4236/jct.2019.1010067

Abstract: Background: Nowadays, laparoscopic colectomy is considered a safe and effective surgical technique regarding short- and long-term outcomes, as well as specific oncologic outcomes. The anastomosis can be created intra- or extracorporeally. The goal of our study was to evaluate and compare short term outcomes of extra- and intra-corporeal anastomosis after laparoscopic right hemi colectomies. Aim of the Study: The goal of our study was to evaluate and compare short term outcomes of extra- and intra-corporeal anastomosis after laparoscopic right hemi colectomies. Methods: In the period from December 2014 to January 2019, all patients underwent laparoscopic right hemicolectomy for cancer colon who presented to surgical oncology department—south Egypt cancer institute and general surgery department—Assiut University was analyzed. Data like age, sex, body mass index (BMI), operative technique, operative times, blood loss, intra- and post

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Estenosis gastroyeyunal en el bypass gástrico por laparoscopia
Leyba,José Luis; Isaac,José; Salvador Navarrete,A; Bravo,Carlos; Salvador Navarrete,Ll; Leamus,Alberto; Gumina,Cono;
Gaceta Médica de Caracas , 2006,

Abstract: gastrojejunal stricture after laparoscopic gastric bypass is a complication reported with all techniques of anastomosis described. in the present study we reviewed the rate of gastrojejunal stricture of 42 patients following laparoscopic gastric bypass by morbid obesity, using a 21 mm circular stapler for such anastomosis. we also evaluated the symptoms, diagnosis, and treatment of this complication, comparing as well the excess body weight loss after dilation, with that of patients without stricture. ten patients (23,8 %) had gastrojejunal stricture, characterized by nausea, vomiting and impossibility to progress food intake up to a complete diet. the symptoms were presented between the 4th and 8th postoperative week and the upper endoscopy was diagnostic in 100 % of the cases. the treatment consisted in endoscopic dilation of the stricture with complete resolution of the clinical symptoms in all the patients. one patient presented a microperforation of the anastomosis following the dilation, treating this with a non operative management. the excess body weight loss one year after surgery didn？t presented significant differences between both groups of patients. we concluded that gastrojejunal stricture after 21 mm circular stapler anastomosis is a frequent complication whose diagnosis and treatment must be done by upper endoscopy. the study of other techniques of laparoscopic gastrojejunostomy is necessary with the aim to reduce these rates maintaining the safety and effectiveness of the procedure.

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What are the current and potential future roles for endoscopic ultrasound in the treatment of pancreatic cancer?
Richard A Kozarek,Shayan Irani,Stephen Y Oh
- , 2016, DOI: 10.4253/wjge.v8.i7.319

Abstract:

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A Modified Technique to Facilitate Anastomosis in Choledochal Cyst [PDF]
Sezen ？zk？sac？k, Mesut Yaz？c？, Harun Gürsoy
International Journal of Clinical Medicine (IJCM) , 2010, DOI: 10.4236/ijcm.2010.12013

Abstract: The method of choice for the treatment of choledochal cysts in children is excision of the cyst and Roux-en-Y (RY) choledochoenterostomy. When the ratio of the diameter of the main hepatic ductus to that of the proximal RY jejunum is 1:2.5 or lower during choledochoenterostomy, end-to-end anastomosis is recommended. However, this method may cause a difference in diameters between the ends. Here we will present the technical difficulty we experienced due to the difference in diameters in end-to-end RY choledochoenterostomy and our modified anastomosis technique of anas¬tomosis. This slight modification eliminated problems with anastomosis caused by a difference in the diameter of the jejunum and shortened operation time.

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Extended Use of Vettath’s Anastomotic Obturator (VAO) [PDF]
Vettath Prabhakaran Murali, Ismail E. Thazhkuni, Kannan A. Vellachamy
Surgical Science (SS) , 2011, DOI: 10.4236/ss.2011.29098

Abstract: Stroke rate in redo coronary artery bypass surgery has remained a stumbling block, where the aorta is used as origin for the top end of the vein graft. Avoiding the side-clamp on these redo aortas by using the Vettath’s Anastomotic Obturator (VAO) technique of anatomosing the vein graft could bring this down. We have also been able to use this technique in combined aortic valve replacement and CABG. These two situations where the VAO is used are elucidated here.

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