Unexplaied jaundice

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    14-Apr-2017
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Transcript of Unexplaied jaundice

ROBOTIC RECONSTRUCTION OF A REVERSED RNYGB IN A PATIENT WITH CONSTANT PAIN AND ALKALINE REFLUX A CASE REPORT

UNEXPLAINED JAUNDICE AFTER ADJUSTMENTS IN A LAGB PATIENT: REPORT OF A VERY RARE CASEKonstantinos Konstantinidis, Savas Hirides, Perikles Chrysoheris, Fotis Antonakopoulos, Petros HiridesAthens Medical Center, Athens, Greece

BackgroundLaparoscopic adjustable gastric banding (LAGB) has been a popular form of weight loss in the past decades. There are a few reports of misplaced bands from inexperienced teams; found too high around the esophagus or in the ante-gastric position around the stomach, but also around the left liver lobe or other bizarre locations.

A rare case of jaundice following adjustments in a LAGB patient is presented in this paper.

MethodsA 46-year old woman who underwent surgery for LAGB placement 7 months prior to her visit to us, presented to our outpatient department with jaundice (bilirubin =3,6)associated with band adjustments. We aspirated 7cc from the band and proceeded with magnetic resonance and computerized tomography, which to our surprise revealed an adjustable band misplaced around the hepatoduodenal ligament.

Immediately the patient was advised for surgical removal of this band.

ApproachA robotic approach was selected for better visualization and dexterity of the instruments in the case of anticipated technical difficulty.

Results

Soon after creation of the pneumoperitoneum the band was found around the hepatoduodenal ligament and the portal triad (hepatic artery, portal vein, common bile duct). A bougie was introduced to the stomach and the duodenum. Careful dissection around the band took place and the band was removed using monopolar scissors and bipolar cautery carefully avoiding the right gastroepiploic vein after entrance to the omental bursa. Following that, careful excision of the reactive capsule was performed. After completion of the procedure, the band and the capsule were removed through the incision for the camera port. A no19 Jackson Pratt drain was put in place.

Patient followed a normal postoperative course and was discharged the following day with normalized bilirubin levels.

LAGBMisplaced AGB

KM Konstantinidis et al. 2015

Conclusions

Laparoscopic adjustable banding has been considered the safest bariatric operation and probably for this reason many inexperienced teams have tried to use it with variable results and increased rates of complications. Experience of the operating team and surgical technique are of extremely high importance for correct placement of the adjustable gastric band.

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