[Endoscopic management of complications after laparoscopic sleeve gastrectomy]

Enhancing the Hypolipidemic and Functional Properties of Flammulina velutipes Root Dietary Fiber via Steam Explosion

Flammulina velutipes is an edible mushroom widely cultivated in China. As a by-product of Flammulina velutipes, the roots are rich in high-quality dietary fiber (DF). In order to obtain high-quality soluble dietary fiber (SDF), steam explosion (SE) is used as an effective modification method to improve the extraction rate and avoid the loss of active substances. Mounting evidence shows that SDF alleviates lipid metabolism disorders. However, it is not well understood how the influence of SDF with SE pretreatment could benefit lipid metabolism. In this study, we extracted a soluble dietary fiber from Flammulina velutipes root with an SE treatment, named SE-SDF, using enzymatic assisted extraction. The physicochemical and structural properties of the SE-SDF were investigated, and its hypolipidemic effects were also analyzed using oleic-acid-induced HepG2 cells. In addition, the anti-obesity and hypolipidemic effects of SE-SDF were investigated using a high-fat diet (HFD) mouse model. The results indicate that SE treatment (1.0 MPa, 105 s) increased the SDF content to 8.73 ± 0.23%. The SE-SDF was primarily composed of glucose, galactose, and mannose. In HFD-fed mice, SE-SDF significantly reduced weight gain and improved lipid profiles, while restoring liver function and reducing injury. This work provides an effective method for the processing of fungi waste and adds to its economic value. In future studies, the structural characteristics and the anti-obesity and gut microbiota regulation mechanisms of SE-SDF will be explored in depth, supporting its high-value utilization in healthcare products.

Migration and section of esophageal thermometer in laparoscopic sleeve gastrectomy: Clinical case of a preventable complication

INTRODUCTION AND IMPORTANCE

Laparoscopic sleeve gastrectomy is a prevalent bariatric surgery for managing morbid obesity. Despite its efficacy, complications can arise, particularly from intraoperative devices such as esophageal thermometers and orogastric tubes. These devices, if misplaced or inadequately monitored, can migrate and become entrapped or sectioned during surgery, leading to significant morbidity.

CASE PRESENTATION

A 49-year-old female with morbid obesity underwent LSG. During surgery, an esophageal thermometer migrated into the stomach and was inadvertently sectioned during the stapling process. This required additional surgical intervention to remove the severed segments and repair the damage. Postoperative recovery was uneventful after corrective measures were taken.

CLINICAL DISCUSSION

This case underscores the critical importance of ensuring the proper placement and continuous monitoring of intraoperative devices, such as esophageal thermometers, to prevent similar preventable complications in future surgical procedures.

CONCLUSION

The reviewed cases demonstrate that complications from intraoperative device migration and entrapment during bariatric surgery, while rare, are significant and preventable. Adherence to strict protocols, continuous device monitoring, and enhanced team communication are essential to improve patient safety and surgical outcomes. Implementing these measures can prevent avoidable complications and enhance the efficacy of bariatric surgeries.

EVIDENCE BASED MEDICINE RANKING

Level IV.