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Gaillard M, Van den Broeck S, Op de Beeck B, Wouters K, Stijns J, Van de Putte D, Gys B, Houben B, Van Dessel E, Bislenghi G, Komen N. Protocol of the LATFIA trial (Laser Assisted Treatment of Fistula in Ano): a multicentre, prospective, randomized controlled trial comparing fistula-tract laser closure (FiLaC™) with rectal advancement flap for high trans-sphincteric fistulas. Colorectal Dis 2024. [PMID: 38499516 DOI: 10.1111/codi.16951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/11/2024] [Accepted: 02/23/2024] [Indexed: 03/20/2024]
Abstract
AIM Anal fistula is one of the most common anal diseases, affecting between 1 and 3 per 10 000 people per year. Symptoms have a potentially severe effect on a patient's quality of life. Surgery is the mainstay of treatment, aiming to cure the fistula and preserve anal sphincter function. Rectal advancement flap (RAF) is currently the gold standard treatment but has recurrence rates varying between 20% and 50% and might lead to disturbance of continence. The aim of the trial described in this work is to discover if the minimally invasive fistula tract laser closure (FiLaC™) technique could achieve higher healing rates and a better functional outcome than RAF. METHOD We will perform a randomized prospective multicentre noninferiority study of the treatment of high trans-sphincteric perianal fistulas, comparing FiLaC™ with RAF in terms of fistula healing, recurrence rate, functional outcome and quality of life. Primary and secondary fistula healing will be evaluated at 26 and 52 weeks' follow-up. Quality of life will be evaluated using the SF-36 questionnaire, the Faecal Incontinence Quality of Life Scale questionnaire and the Vaizey score at 3, 6, 12 and 26 weeks postoperatively. CONCLUSION High trans-sphincteric fistulas have a potentially severe effect on a patient's quality of life. Classical treatment with RAF is a time-consuming invasive procedure. The LATFIA trial aims to compare FiLaC™ with the gold standard treatment with RAF. In case of noninferiority, FiLaC™ treatment could be standardized as a first line treatment for high trans-sphincteric fistulas. Better conservation of the patient's anal sphincter function could possibly be obtained. Likewise, we will report on the postoperative quality of life when applying these two techniques.
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Affiliation(s)
- Marie Gaillard
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
- Antwerp ReSURG, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Sylvie Van den Broeck
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
- Antwerp ReSURG, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Bart Op de Beeck
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
| | - Kristien Wouters
- Clinical Trial Center, Antwerp University Hospital, Edegem, Belgium
| | - Jasper Stijns
- Department of Abdominal Surgery, University Hospital Brussels, Jette, Belgium
| | - Dirk Van de Putte
- Department of Abdominal Surgery, University Hospital Ghent, Ghent, Belgium
| | - Ben Gys
- Department of Abdominal Surgery, Hospital St. Dimpna, Geel, Belgium
| | - Bert Houben
- Department of Abdominal Surgery, Jessa Hospital, Hasselt, Belgium
| | - Els Van Dessel
- Department of Abdominal Surgery, GasthuisZusters Hospital, Antwerp, Belgium
| | - Gabriele Bislenghi
- Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - Niels Komen
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
- Antwerp ReSURG, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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Depauw L, De Weerdt G, Gys B, Demeulenaere S, Mebis W, Ysebaert D. Pediatric fibrolamellar hepatocellular carcinoma: case report and review of the literature. Acta Chir Belg 2021; 121:204-210. [PMID: 34082642 DOI: 10.1080/00015458.2019.1660060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND A 13-year-old boy presented with acute abdominal pain in the right upper quadrant without previous trauma. Abdominal ultrasound (US) revealed a mass in the right liver lobe with free intraperitoneal fluid, suggestive for hemoperitoneum. Magnetic resonance imaging confirmed a subcapsular lesion (5.7 × 4.6 × 4.1 cm), suggestive for fibrolamellar hepatocellular carcinoma (FL-HCC). Positron emission tomography-computed tomography revealed mild to moderate fluorodeoxyglucose (FDG) avidity, with no other FDG avid lesions. Hepatic tumor markers were negative. CASE REPORT An elective right hepatectomy with cholecystectomy and hilar lymph node resection was performed. RESULTS Histology showed a central fibrous scar and confirmed a FL-HCC (pT1bN0M0). The resected lymph nodes were tumor-free. Treatment of FL-HCC should consist of complete tumor resection with concurrent lymph node resection +/- orthotopic liver transplantation. Long-term follow-up is advised. A follow-up interval of 3-4 months in the first 2 years after surgical resection can be justified as FL-HCC have a high recurrence rate of more than 50% within 10-33 months. CONCLUSIONS Malignancy can be a rare cause of abdominal pain in pediatric patients. An abdominal US is essential to prevent misdiagnosis. Treatment of FL-HCC should consist of R0 tumor resection with concurrent lymphadenectomy +/- orthotopic liver transplantation.
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Affiliation(s)
- Laura Depauw
- Department of Hepatobiliairy Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Glenn De Weerdt
- Department of Hepatobiliairy Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Ben Gys
- Department of Hepatobiliairy Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Sofie Demeulenaere
- Department of Hepatobiliairy Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Wouter Mebis
- Department of Hepatobiliairy Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Dirk Ysebaert
- Department of Hepatobiliairy Surgery, Antwerp University Hospital, Antwerp, Belgium
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Ruyssers M, Gys B, Jawad R, Mergeay M, Janssen L, Van Houtert C, Gys T, Lafullarde T. Enhanced Recovery After Revisional Bariatric Surgery: a Retrospective Study of 321 Patients with Laparoscopic Conversion of Failed Gastric Banding or Failed Mason Gastroplasty to Roux-en-Y Gastric Bypass. Obes Surg 2021; 31:2136-2143. [PMID: 33559818 DOI: 10.1007/s11695-021-05235-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/08/2021] [Accepted: 01/14/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE With the rising incidence of failed bariatric procedures, the importance of revisional surgery has been increasing. These revisional procedures come with a higher risk of complications leading to longer hospital stays. We believe though that enhanced recovery after revisional bariatric surgery is possible and needs to be advocated. MATERIALS AND METHODS We retrospectively analyzed our laparoscopic conversions of failed gastric banding and failed Mason gastroplasty to Roux-en-Y gastric bypass. A total of 321 patients was included in the study, from February 2010 until December 2019. The primary endpoints were length of stay (LoS), in-hospital complication rate, and early readmission rate (< 30 days). Logistic regression was used to investigate the impact of several independent variables on complication and readmission rates. RESULTS Fifty-four patients were male and 267 female. The mean age was 44.2 years and mean BMI at the time of conversion was 37.9 kg/m2. We converted 273 failed adjustable gastric bandings (85,0%) and 48 failed Mason gastroplasties (15.0%). The main reason for conversion was the recurrence of obesity. A mean LoS of 2.10 days was calculated. We had an overall in-hospital complication rate of 3.73% and the overall early readmission rate was 3.43%. The odds ratio for LoS on early readmission is 1.52 (p=0.0079; CI 95% [1.12-2.07]). CONCLUSION The above data imply that the implementation of advanced ERAS principles for revisional surgery in our center is safe and does not lead to a higher risk of early readmission.
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Affiliation(s)
| | - Ben Gys
- AZ Sint Dimpna Hospital, Geel, Belgium
| | - Rami Jawad
- University Hospital Brussels, Brussels, Belgium
| | | | | | | | - Tobie Gys
- AZ Sint Dimpna Hospital, Geel, Belgium
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Abstract
Background: An internal abdominal hernia is defined as the protrusion of a viscus through a mesenteric or peritoneal aperture within the peritoneal cavity. A less common type of internal herniation is a small bowel herniation through a defect in the falciform ligament of the liver. This defect can be congenital or iatrogenic after penetration of the falciform ligament with a trocar during laparoscopic surgery. Methods: We present a case report illustrating an internal herniation through an iatrogenic defect in the falciform ligament of the liver. Results: A 78-year-old man comes to the emergency department with severe abdominal pain for several hours. Laparoscopic exploration shows a small bowel herniation through an iatrogenic defect of the falciform ligament after laparoscopic cholecystectomy. Reduction of the internal herniation is performed. Due to subsequently small bowel necrosis, a small bowel resection with primary anastomosis has to be performed too. Conclusion: Small bowel herniation through an iatrogenic defect in the falciform ligament is very rare. However, it can lead to severe complications such as small bowel necrosis. To prevent internal herniation, we strongly suggest immediate repair or division of the falciform ligament when an iatrogenic defect is created during laparoscopic procedures.
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Affiliation(s)
- Gino Vissers
- Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Arno Talboom
- Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Ben Gys
- Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Damien Desbuquoit
- Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
| | - Niels Komen
- Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Guy Hubens
- Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
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Ruyssers M, Jawad R, Gys B, Gys T, Lafullarde T. Ivor Lewis Oesophagectomy for a Distal Adenocarcinoma of the Oesophagus 10 Years After Roux-en-Y Gastric Bypass (RYGB). Obes Surg 2019; 29:2713-2714. [DOI: 10.1007/s11695-019-03938-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gys B, Gielis JF, Texeira MB, Ruyssers M, Gys T, Lafullarde T. Letter to the Editor-Laparoscopic Conversion of One Anastomosis Gastric Bypass to Roux-en-Y Gastric Bypass. Obes Surg 2019; 29:1367. [PMID: 30725430 DOI: 10.1007/s11695-019-03714-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ben Gys
- Department of Surgery, Sint-Dimpna Hospital, Geel, Belgium.
| | - Jan F Gielis
- Department of Surgery, Sint-Dimpna Hospital, Geel, Belgium
| | | | | | - Tobie Gys
- Department of Surgery, Sint-Dimpna Hospital, Geel, Belgium
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Gys B, Mertens J, Ruppert M, Hubens G. Cronkhite-Canada syndrome causing pouch outlet obstruction 5 years after roux-en-y gastric bypass. Acta Chir Belg 2019; 119:56-58. [PMID: 29202677 DOI: 10.1080/00015458.2017.1411556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We present the case of a 57-year-old man with a history of Roux-en-Y gastric bypass (RYGB) and colonic polyps who presented with an upper gastrointestinal obstruction based on massive stomach polyposis in the pouch. METHODS Two months prior to this acute admission, he had undergone resection of the gastric remnant due to massive refractory intraluminal bleeding from a polypoid mass. Ten years earlier, right colectomy was performed due to hypertrophic polyposis unsuitable for endoscopic polypectomy. Upper gastrointestinal endoscopy showed a polypoid mass in the pouch causing obstruction. Benign biopsies were obtained. A resection of the stomach pouch with esophagojejunostomy was performed. Macroscopic evaluation of the pouch lumen showed massive polyposis with a sharp demarcation near the Z-line and at the gastrojejunostomy. On clinical examination, the presence of atrophic nail changes, alopecia, and palmar hyperpigmentation was noticed. RESULTS Postoperative course was uneventful and feeding was restarted successfully. Histological analysis revealed hyperplastic polypoid tissue, which resembled the polyps in the stomach remnant and colon. Together with the ectodermal changes, the diagnose of Cronkhite-Canada syndrome was established. CONCLUSION Diffuse polyposis in Cronkhite-Canada syndrome is a rare cause for pouch obstruction after RYGB. Clinical examination should focus on dermatologic findings.
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Affiliation(s)
- Ben Gys
- Dienst Abdominale, Kinder- en Reconstructieve Heelkunde, UZA, Antwerpen, Belgium
| | - Joren Mertens
- Dienst Abdominale, Kinder- en Reconstructieve Heelkunde, UZA, Antwerpen, Belgium
| | - Martin Ruppert
- Dienst Abdominale, Kinder- en Reconstructieve Heelkunde, UZA, Antwerpen, Belgium
| | - Guy Hubens
- Dienst Abdominale, Kinder- en Reconstructieve Heelkunde, UZA, Antwerpen, Belgium
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Gys B, Fransis K, Hubens G, Van den Broeck S, Op de Beeck B, Komen N. Simultaneous laparoscopic proctocolectomy (TaTME) and robot-assisted radical prostatectomy for synchronous rectal and prostate cancer. Acta Chir Belg 2019; 119:47-51. [PMID: 29198168 DOI: 10.1080/00015458.2017.1411550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE We would like to present a patient with a history of ulcerative colitis suffering from a synchronous rectal and prostate cancer treated with a laparoscopic total proctocolectomy (with TaTME) and Retzius sparing RARP simultaneously. METHODS Retzius sparing RARP with bilateral lymph node harvesting was performed first. Afterwards, TaTME was commenced with the placement of a Lonestar® retractor and GelPort®. Anterior dissection was troubled unexpectedly by outspoken fibrosis. For that reason, it was completed laparoscopically. We then continued with the laparoscopic total proctocolectomy. Last, a transanal circular stapled ileoanal anastomosis was created and a derivating ileostomy was installed. RESULTS Postoperative proctoscopy showed a patent ileoanal anastomosis. After removal of the Foley catheter on day 21, the patient was immediately continent. Prostate specimen revealed a pT2cN1M0 transmural invasive adenocarcinoma with a Gleason score of 7 (3 + 4). Pathology analysis of the rectum revealed a stage IIIc transmural invasive moderately differentiated rectal adenocarcinoma (pT3N2bM0) with free margins. He was referred for adjuvant chemotherapy. CONCLUSIONS In this case, the combination of TaTME and Retzius sparing RARP for synchronous rectal and prostate cancer was feasible and safe. We suggest performing the anterior TaTME dissection last, due to disturbing blood flow into the operating field after prostatectomy.
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Affiliation(s)
- Ben Gys
- Dienst Abdominale, Kinder-en Reconstructieve Heelkunde, UZA, Antwerpen, Belgium
| | | | - Guy Hubens
- Dienst Abdominale, Kinder-en Reconstructieve Heelkunde, UZA, Antwerpen, Belgium
| | | | | | - Niels Komen
- Dienst Abdominale, Kinder-en Reconstructieve Heelkunde, UZA, Antwerpen, Belgium
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Abstract
BACKGROUND Fistula formation in hidradenitis suppurativa follows an uncontrolled infection with subcutaneous tracts leading to 'watering-can' or 'pus-pot' perineum. Closure of this type of fistula implies major surgery and is bound to fail in refractory inflammatory environment. Minimally invasive techniques have become the first line of choice in every type of surgery. METHODS Fistula-tract Laser Closure (FiLaC™, Biolitec, Germany) is a novel technique already reported to have been used in the treatment of fistula-in-ano and pilonidal sinus. It consists of blind cauterization and obliteration of the fistula tract from the inside by means of a radial-emitting laser probe. We present two patients who underwent surgery for urethroperineal fistula using this technique. RESULTS In both cases, the fistula tracts were completely closed after 3 months of follow-up. The wounds had healed smoothly and complete resolution of symptoms was noted. CONCLUSIONS The use of FiLaC™ for the treatment of urethroperineal fistula is feasible and safe. The minimally invasive nature of the technique and limited postoperative pain permit daycare surgery.
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Affiliation(s)
- Ben Gys
- Department of Abdominal Surgery, AZ Sint-Dimpna, Geel, Belgium
| | - Nicolas De Hous
- Department of Abdominal Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - Guy Hubens
- Department of Abdominal Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - Gunter De Win
- Department of Urology, University Hospital of Antwerp, Edegem, Belgium
| | - Niels Komen
- Department of Abdominal Surgery, University Hospital of Antwerp, Edegem, Belgium
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Gys B, Haenen F, Moreels T. Re: "Laparoscopic Roux-en-Y Gastric Bypass: Surgical Technique and Tips for Success" (J Laparoendosc Adv Surg Tech A 2018;28:938-943). J Laparoendosc Adv Surg Tech A 2018; 29:76. [PMID: 30418083 DOI: 10.1089/lap.2018.0609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ben Gys
- 1 Department of Abdominal Surgery, Sint-Dimpna Hospital, Geel, Belgium
| | - Filip Haenen
- 1 Department of Abdominal Surgery, Sint-Dimpna Hospital, Geel, Belgium
| | - Tom Moreels
- 2 Department of Gastroenterology and Hepatology, University Hospital Saint-Luc, Brussels, Belgium
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Gys B, Haenen F, Moreels T. The importance of long-term postoperative follow-up, including low threshold for endoscopic examination of the remnant stomach after Roux-en-Y gastric bypass. J Minim Access Surg 2018; 15:279. [PMID: 30106028 PMCID: PMC6561059 DOI: 10.4103/jmas.jmas_166_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Ben Gys
- Department of Surgery, AZ Sint Dimpna, Geel, Belgium
| | - Filip Haenen
- Department of Surgery, AZ Sint Dimpna, Geel, Belgium
| | - Tom Moreels
- Department of Gastroenterology and Hepatology, University Hospital Saint-Luc, Brussels, Belgium
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Haenen FW, Gys B, Moreels T, Michielsen M, Gys T, Lafullarde T. Linitis plastica of the bypassed stomach 7 years after Roux-en-Y gastric bypass: a case report. Acta Chir Belg 2017; 117:391-393. [PMID: 27397038 DOI: 10.1080/00015458.2016.1192839] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Laparoscopic Roux-en-Y gastric bypass (RYGB) is currently the preferred surgical procedure to treat morbid obesity. It has proven its effects on excess weight loss and its positive effect on comorbidities. One of the main issues, however, is the post-operative evaluation of the bypassed gastric remnant. In literature, cancer of the excluded stomach after RYGB is rare. We describe the case of a 52-year-old woman with gastric linitis plastica in the bypassed stomach after Roux-en-Y gastric bypass, diagnosed by means of laparoscopy and Single-Balloon enteroscopy, and it is clinical importance. Linitis plastica of the excluded stomach after RYGB is a very rare entity. This case report shows the importance of long-term post-operative follow-up, and the importance of single-balloon enteroscopy for visualization of the bypassed stomach remnant, when other investigations remain without results. This case report is only the second report of a linitis plastica in the bypassed stomach after Roux-en-Y gastric bypass.
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Affiliation(s)
- Filip Wn Haenen
- Department of General and Abdominal Surgery, St. Dimpna General Hospital, Geel, Belgium
| | - Ben Gys
- Department of General and Abdominal Surgery, St. Dimpna General Hospital, Geel, Belgium
| | - Tom Moreels
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium
| | - Maartje Michielsen
- Department of General and Abdominal Surgery, St. Dimpna General Hospital, Geel, Belgium
| | - Tobie Gys
- Department of General and Abdominal Surgery, St. Dimpna General Hospital, Geel, Belgium
| | - Thierry Lafullarde
- Department of General and Abdominal Surgery, St. Dimpna General Hospital, Geel, Belgium
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Gys B, Gys T, Lafullarde T. The Use of Unidirectional Knotless Barbed Suture for Enterotomy Closure in Roux-en-Y Gastric Bypass: a Randomized Comparative Study. Obes Surg 2017; 27:2159-2163. [PMID: 28281235 DOI: 10.1007/s11695-017-2628-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE In this study, we assessed feasibility, safety, and time efficiency of laparoscopic running enterotomy closure for linear stapled Roux-en-Y Gastric Bypass (RYGB) using unidirectional barbed sutures (Stratafix™ 2/0- Ethicon). MATERIALS AND METHODS Two hundred patients undergoing laparoscopic RYGB were prospectively randomized regarding running enterotomy closure of the linear stapled gastrojejunal (GJA) and jejunojejunal anastomosis (JJA). Two groups were created: V-group (Vicryl® 2/0-Ethicon) and S-group (Stratafix™ 2/0-Ethicon). Time spent on closing the enterotomies was measured from first needle in until knot and cut (V-group) or last stitch and cut (S-group). If needed, a nonabsorbable "correction" ("c"; in order to close a small hiatus at the anastomosis) or hemostatic ("h") stitch was made (using a single Prolene® 2/0-Ethicon). RESULTS Average total procedure time was similar (S-group 1:01:22, V-group 1:00:44, P = 0.340). Closure of the enterotomy (GJA) was significantly shorter in the S-group (07:41 min versus 08:13 min in the V-group, P = 0.005). Extra stitches (GJA) were performed in 33 patients (16.5%): 3 (h) and 20 (c) in the V-group and 1 (h) and 9 (c) in the S-group. Four patients in the V-group suffered from postoperative intraluminal bleeding (3 self-limiting, 1 underwent endoscopic clipping). In the S-group, 1 patient suffered from leakage at the vertical transected staple line of the stomach. CONCLUSIONS The use of unidirectional barbed sutures for running enterotomy closure after linear stapled RYGB is feasible and safe. Significant time benefit was seen regarding the closure of the GJA. Fewer additional stitches were necessary and postoperative intraluminal bleeding was less encountered.
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Affiliation(s)
- Ben Gys
- J-.B. Stessensstraat 2, B-2440, Geel, Belgium.
| | - Tobie Gys
- J-.B. Stessensstraat 2, B-2440, Geel, Belgium
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Gys B, Gys T, Ruyssers M, Lafullarde T. Laparoscopic Linear Stapled Running Enterotomy Closure in Roux-en-Y Gastric Bypass Using Absorbable Unidirectional Barbed Suture (Stratafix® 2/0). Obes Surg 2017; 27:2740-2741. [DOI: 10.1007/s11695-017-2870-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gys B, Peeters D, Driessen A, Snoeckx A, Komen N. Adult suprapatellar pleiomorphic rhabdomyosarcoma with jejunal metastasis causing intussusception: a case report. Acta Chir Belg 2016; 116:376-378. [PMID: 27426662 DOI: 10.1080/00015458.2016.1181371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Jejuno-jejunal intussusception is rarely encountered in adults. Management depends on the viability of the involved bowel. Exploration is favored because in adults generally an underlying 'lead point' is found to be present. Pleimorphic rhabdomyosarcoma (pRMS) arises from striated muscle cells. They are usually diagnosed during childhood and can occur virtually all over the body, controversially in places were few striated cells are found. In adults, these tumors are rare and are mostly encountered in the head-and-neck region. We present the case of a 48-year-old woman with a jejunal metastasis from a suprapatellar pRMS diagnosed 2.5 years earlier resulting in a jejuno-jejunal intussusception.
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Affiliation(s)
- Ben Gys
- Dienst Abdominale, Kinder- en Reconstructieve Heelkunde, UZA, Antwerpen, België
| | | | - Ann Driessen
- Dienst Pathologische Anatomie, UZA en Universiteit Antwerpen, Antwerpen, België
| | | | - Niels Komen
- Dienst Abdominale, Kinder- en Reconstructieve Heelkunde, UZA, Antwerpen, België
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Haenen F, Gys B, Gys T, Lafullarde T. Roux-en-Y gastric bypass for obesity after Belsey-Mark IV for large hiatus hernia and intrathoracic stomach, in combination with gastroesophageal reflux disease. Acta Chir Belg 2016; 116:175-177. [PMID: 27414636 DOI: 10.1080/00015458.2015.1128209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Obesity is an increasing problem worldwide; patients who remain obese after non-surgical interventions are potential candidates for surgical intervention. Laparoscopic Roux-en-Y gastric bypass (RYGB) has proven its effects on excess weight loss and its positive effect on comorbidities and also, on reflux correction. CASE REPORT Our patient, a 53-year-old male, with a BMI of 45 kg/m2 and type 2 diabetes, underwent a Belsey-Mark IV procedure in another center because of a large hiatus hernia and intrathoracic stomach, in combination with gastroesophageal reflux disease (GERD). He consulted at our center concerning his morbid obesity. After a positive preoperative evaluation a RYGB was performed with an uneventful postoperative course. CONCLUSION RYGB is a safe and feasible procedure to perform after a Belsey-Mark IV procedure. To our knowledge, this is the first and only report of a RYGB after a Belsey-Mark IV procedure. There were no intra-operative complications and 18 months follow-up was unremarkable, with a 78.10% excess weight loss (EWL), at 86 kg, and no remaining symptoms of GERD. We also mention resolution of the patient's diabetes mellitus type 2 measured by the cessation of the glucophage, which is an added health benefit.
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Gys B, Gys T, Lafullarde T. The Efficacy of Laparoscopic Roux-En-Y Gastric Bypass after Previous Anti-Reflux Surgery: A Single Surgeon Experience. Acta Chir Belg 2015; 115:268-72. [PMID: 26324027 DOI: 10.1080/00015458.2015.11681110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND In this study we assessed feasibility, weight loss results and recurrence of Gastro-Oesophageal Reflux Disease (GORD) in patients undergoing laparoscopic Roux-en-Y Gastric Bypass (RYGB) after previous anti-reflux surgery. METHODS Retrospective analysis of prospectively collected data was performed for patients undergoing laparoscopic RYGB after previous anti-refux surgery between 1/1/2000 and 1/1/2015. Weight loss was assessed using %Excess Weight Loss (%EWL) and every patient was compared with two matched control subjects. Telephone interviews were conducted to assure maximum follow-up data. Quality Of Life (QOL) was assessed using the Gastro-Intestinal Quality of Life Index (GIQLI), Gastro-intestinal Symptom Rating Scale (GSRS) and Bariatric Analysis and Reporting Outcome System (BAROS). RESULTS A total of 18 patients (11 female, 7 male) were identified (17 Nissen and 1 former Belsey-Mark IV fundoplication). Mean time between surgical interventions was 9.4 years. Laparoscopic RYGB was feasible without intra-operative complications. One patient needed relaparoscopy for falsely suspected leakage and another suffered from postoperative pneumonia. Symptomatic GORD after RYGB was reported by 3 patients (16.7%). QOL was rated good with a GIQLI-score of 118 (range 97-140), GSRS score of 33 (range 15-59) and BAROS-score of 4,6 (range 1.2-6.8). EWL 3 years after surgery was comparable with matched control subjects (80.1% vs. 79.2% in controls, P=0.70). CONCLUSIONS Laparoscopic conversion of anti-reflux surgery to RYGB with breakdown of the fundoplication is feasible and safe. Weight loss results are equal to control subjects and treatment of GORD is good. No significant decrease in QOL was reported.
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Gys B, Demaeght D, Hubens G, Ruppert M, Vaneerdeweg W. Herniation of a Meckel's diverticulum in the Umbilical Cord. J Neonatal Surg 2014; 3:52. [PMID: 26023523 PMCID: PMC4420330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 10/09/2014] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ben Gys
- Department of Surgery, AZ St Dimpna, Geel, Belgium
,Correspondence: Ben Gys, J.B. Stessensstraat 2 - 2440 Geel, Belgium.
| | | | - Guy Hubens
- Department of Abdominal Surgery, University Hospital Antwerp, Belgium
| | - Martin Ruppert
- Department of Abdominal Surgery, University Hospital Antwerp, Belgium
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Abstract
Please see fulltext
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Gys B, Haenen F, Gys T. Ileocolic Intussusception Caused by a Giant Ulcerating Lipoma of Bauhin's Valve: an Unusual Cause of Intestinal Obstruction in the Adult. Indian J Surg 2014; 77:1-2. [PMID: 25972625 DOI: 10.1007/s12262-013-1023-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 12/17/2013] [Indexed: 10/25/2022] Open
Abstract
We report a case of intestinal obstruction in a 73-year-old woman caused by ileocolic intussusception. The underlying cause was a giant submucosal ulcerating lipoma (6 × 3.3 × 3.8 cm) extending from the superior mucosal lip of Bauhin's valve. Abdominal ultrasonography showed a pathognomonic target-like mass appearing as multiple concentric rings. CT scan confirmed the diagnosis. Because of apparent obstruction, a laparotomy with right hemicolectomy and ileocolic anastomosis was performed. Lipomas most frequently occur in the cecum and ascending colon where they represent the most common submucosal mesenchymal tumor. They typically occur in elderly women with an incidence that varies from 0.15 to 0.56 %. Pain, rectal bleeding, and obstruction are typical symptoms. When faced with an intussusception in children, reduction with air per rectum can be performed. In adults, however, malignant cell spreading and seeding is of big concern. Since approximately 20-50 % of all underlying causes are malignant, explorative surgery is favored in adults.
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Affiliation(s)
- B Gys
- Department of Surgery, AZ St. Dimpna Geel, J.-B. Stessensstraat 2, 2440 Geel, Belgium
| | - F Haenen
- Department of Surgery, AZ St. Dimpna Geel, J.-B. Stessensstraat 2, 2440 Geel, Belgium
| | - T Gys
- Department of Surgery, AZ St. Dimpna Geel, J.-B. Stessensstraat 2, 2440 Geel, Belgium
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Gys T, Gys B, Lafullarde T. The use of a self-gripping mesh in open inguinal hernia repair. A prospective observational single surgeon study. Acta Chir Belg 2013; 113:192-5. [PMID: 24941715 DOI: 10.1080/00015458.2013.11680910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The Lichtenstein repair is a well standardized surgical technique that can mostly be performed in day-clinic under loco-regional anesthesia. The major concern is the chronic pain reported after mesh suture fixation. We studied the practical and clinical aspects of a Lichtenstein repair using the semi-resorbable self-fixating Parietex ProGrip mesh. METHODS Consecutive patients with inguinal hernia were operated according to the Lichtenstein technique using Parietex ProGrip. Complications were assessed. Pain and discomfort were evaluated at discharge, and at 1 and 4 weeks and minimum 6 months after the intervention. RESULTS 320 patients were included in the study. No intra-operative complications or difficulties occurred. Mean operating time was 36 minutes (range 20-65 minutes). 87.5% of the patients (280) were discharged at day of operation, 11.9% (38 patients) had an overnight stay and 0.6% (2 patients) stayed two nights. Mean number of days of analgesic use is 2.1. At the 1 week follow-up visit, minor pain or discomfort was reported by 45 patients (14%) and at 4 weeks 11 patients (3.4%) still had minor discomfort. At 6 months 1 patient suffered from persisting local numbness. Two recurrences were noted, both were re-operated. CONCLUSIONS This observational study confirms earlier findings with this semi-resorbable self-gripping mesh regarding operation time, complications and recurrence. The open Lichtenstein hernia repair with the semi-resorbable self-gripping Parietex Progrip mesh seems to offer a reliable alternative for the treatment of inguinal hernia with benefits on operating time as well as on postoperative pain.
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Affiliation(s)
- T. Gys
- Department of abdominal surgery, AZ St.-Dimpna Hospital, Geel, Belgium
| | - B. Gys
- Student, Faculty of Medicine, University of Antwerp, Antwerp, Belgium
| | - T. Lafullarde
- Department of abdominal surgery, AZ St.-Dimpna Hospital, Geel, Belgium
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