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Annals of Bariatric Surgery - Volume:8 Issue: 1, Winter and Spring 2019

Annals of Bariatric Surgery
Volume:8 Issue: 1, Winter and Spring 2019

  • تاریخ انتشار: 1398/06/19
  • تعداد عناوین: 3
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  • Matin Ghazizadeh , Golfam Mehrparvar * Page 1
    Objectives
    To evaluate the success rate of endoscopic repair of CSF leak and factors with potential effect on surgical outcome.
    Methods
    A case series study based on review of medical records and follow up of patients admitted at three hospitals during a 5 year period.
    Results
    Of 43 operated patients 38 (88.4%) had successful result after first surgical attempt. Defect size, number of graft layers, graft placement technique-underlay vs. overlay-lumbar drain placement or serial lumbar punctures did not show a statistically significant association with surgical outcome. Definite determination of defect site before or during operation had a relationship with surgical success with a P value of 0.06 there was a significant correlation between the number of layers on the defect site and immediate postoperative improvement.
    Conclusions
    Endoscopic repair of CSF leak has been proven as a successful method with reported success rate of above 80 percent. Careful attempt to find the exact site of CSF leak is recommended. We do not suggest the routine use of lumbar drains, serial post op lumbar punctures and intrathecal fluorescine due to their potential complications and no evidence for their efficacy.
    Keywords: Cerebrospinal Fluid, Cerebrospinal Fluid Leak, Endoscopic Repair
  • Mostafa Sadeghi , Shaghayegh Beshtar , Moussa Abolhassani, Alireza Tavassoli * Page 2
    Introduction
    In this study, we report a case of meshoma with ventral hernia recurrence symptoms after the use of mesh.
    Case Presentation
    A 52-year-old woman who had two ventral hernia surgery presented to our department. In the second surgery, a mesh is used to repair the position. After 6 months of the second surgery, she was refered to us with symptoms of acute cholecystitis. In pathologic examination, sections of mesh with interaction of a foreign body around it, including chronic inflammatory infiltration, bud cells of foreign body together with surrounding hyalinized irregular fibrotic fibers amidst the adipose tissue in the abdominal wall could be observed.
    Conclusions
    Although using mesh is a suitable tool to repair abdominal wall defects, mesh shrinkage and meshoma could be considered as its rare complications while it is possible to regard it as the differential diagnosis in hernia repair with the mesh in the cases of abdominal wall masses.
    Keywords: Meshoma, Abdomen, Hernia, Surgery, Case Report
  • Basim Alkhafaji , Muhammad Umar Younis *, Yousif Alkhafaji Page 3
    Introduction
    A possible complication that may present late after Roux-en-Y gastric bypass is the development of marginal ulcer at the gastrojejunostomy site. We discuss here an emergency presentation of a case with a delayed perforation at the anastomosis 5 months after surgery which dealt successfully with the laparoscopic approach.
    Case Presentation
    A 45-year-old female presented to the emergency department for evaluation of severe upper abdominal pain. Her past history was significant for laparoscopic Roux-en-Y gastric bypass surgery for weight loss done in Oct 2016 and further denied any history of chronic medication, alcoholism, smoking or any co-morbidity. She was examined and found to have a tenderness all over the abdomen with sluggish bowel sounds and decreased air entry at bases bilaterally, more so on the left side. Portable CXR revealed air under the diaphragm and an obliterated left costophrenic angle. A repeat CT scan with gastrograffin contrast was carried out and findings confirmed a perforation at the site of gastrojejunal anastomosis with free fluid in the pelvis and flanks. She underwent laparoscopic exploration and repair of anastomotic perforation with omental patch and was discharged in a healthy fashion on her 7th postoperative day.
    Conclusions
    This case report corroborates with literature available from many sources that marginal ulcer perforation is one of the serious complications after Roux-en-Y gastric bypass and may present early in the first few months or as a delayed entity years after the surgery. Once diagnosed, urgent intervention is required and laparoscopic repair has shown itself a safe and effective treatment strategy where facilities are available.
    Keywords: Laparoscopy, Roux-en-Y Gastric Bypass, Marginal Ulcer, Bariatric Surgery, Case Report