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Murine models are often used to study the pathogenicity and dissemination of the enteric pathogen Salmonella enterica serovar Typhimurium. Here, we quantified S. Typhimurium population dynamics in mice using the STAMPR analytic pipeline and a highly diverse S. Typhimurium barcoded library containing ~55,000 unique strains distinguishable by genomic barcodes by enumerating S. Typhimurium founding populations and deciphering routes of spread in mice. We found that a severe bottleneck allowed only one in a million cells from an oral inoculum to establish a niche in the intestine. Furthermore, we observed compartmentalization of pathogen populations throughout the intestine, with few barcodes shared between intestinal segments and feces. This severe bottleneck widened and compartmentalization was reduced after streptomycin treatment, suggesting the microbiota plays a key role in restricting the pathogen's colonization and movement within the intestine. Additionally, there was minimal sharing between the intestine and extraintestinal organ populations, indicating dissemination to extraintestinal sites occurs rapidly, before substantial pathogen expansion in the intestine. Bypassing the intestinal bottleneck by inoculating mice via intravenous or intraperitoneal injection revealed that Salmonella re-enters the intestine after establishing niches in extraintestinal sites by at least two distinct pathways. One pathway results in a diverse intestinal population. The other re-seeding pathway is through the bile, where the pathogen is often clonal, leading to clonal intestinal populations and correlates with gallbladder pathology. Together, these findings deepen our understanding of Salmonella population dynamics. [ABSTRACT FROM AUTHOR]

Bariatric surgery is an effective treatment for type 2 Diabetes Mellitus (T2DM), yet the precise mechanisms underlying its effectiveness remain incompletely understood. While previous research has emphasized the role of rearrangement of the gastrointestinal anatomy, gaps persist regarding the specific impact on the gut microbiota and barriers within the biliopancreatic, alimentary, and common limbs. This study aimed to investigate the effects of duodenal-jejunal bypass (DJB) surgery on obese T2DM mice. We performed DJB and SHAM surgery in obese T2DM mice to investigate changes in the gut microbiota and barrier across different intestinal limbs. The effects on serum metabolism and potential associations with T2DM improvement were also investigated. Following DJB surgery, there was an increased abundance of commensals across various limbs. Additionally, the surgery improved intestinal permeability and inflammation in the alimentary and common limbs, while reducing inflammation in the biliopancreatic limbs. Furthermore, DJB surgery also improved T2DM by increasing L-glutamine, short-chain fatty acids, and bile acids and decreasing branched-chain amino acids. This study underscores the role of intestinal rearrangement in reshaping gut microbiota composition and enhancing gut barrier function, thereby contributing to the amelioration of T2DM following bariatric surgery, and providing new insights for further research on bariatric surgery. [ABSTRACT FROM AUTHOR]

Introduction: Patients with familial adenomatous polyposis (FAP) are characterised by the appearance of colorectal cancer if the disease is left to follow its natural course, which means they frequently undergo prophylactic colectomy at a young age. In these patients, duodenal cancer becomes the leading cause of death, which deems surveillance necessary. Gastric cancer, although rare, can also occur in these patients, and total gastrectomy is the usual treatment option. Patients and Methods: We used a pedicled isoperistaltic jejunal flap interposition technique to reconstruct the digestive tract after a total gastrectomy so that duodenal surveillance could be maintained in patients followed in outpatient consultation for genetic diseases. We also describe how this technique was performed fully through laparoscopy in two of these cases. Results: We identified four patients with FAP who developed malignant or extensive pre-malignant gastric lesions which were not endoscopically resectable. Two patients were submitted to open surgery and the remaining two underwent laparoscopic surgery. There was no perioperative or post-operative morbidity, and all four patients are alive at the time of writing, with a minimum follow-up of 12 months. They were not diagnosed with major nutritional imbalances and were routinely submitted to endoscopic duodenal surveillance, sometimes including polypectomy, with ease. Conclusion: In our experience, this surgical technique has good results, and all surgical steps can be done entirely through laparoscopy, with every advantage this approach entails. [ABSTRACT FROM AUTHOR]

Context The liver/foregut satiety hormone liver-expressed antimicrobial peptide 2 (LEAP2) is an inverse agonist at the acyl ghrelin receptor (GHSR), increasing after food intake and decreasing after bariatric surgery and short-term nonsurgical weight loss, but effects of long-term dietary weight loss are unknown. Objective The objective of this study was to examine and compare the effects of these interventions on fasting and postprandial plasma LEAP2 and investigate potential metabolic mediators of changes in plasma LEAP2. Methods Plasma LEAP2 was measured in a previously published 2-year trial comparing standard medical management (SMM) (including 600-kcal/day deficit) with duodenal-jejunal bypass liner (DJBL, Endobarrier) insertion (explanted after 1 year) in adults with obesity and inadequately controlled type 2 diabetes mellitus. Results In the SMM group (n = 25-37), weight decreased by 4.3%, 8.1%, 7.8%, and 6.4% at 2, 26, 50, and 104 weeks and fasting plasma LEAP2 decreased from baseline mean ± SD 15.3 ± 0.9 ng/mL by 1.7, 3.8, 2.1, and 2.0 ng/mL, respectively. Absolute/decreases in fasting plasma LEAP2 positively correlated with absolute/decreases in body mass index, glycated hemoglobin A1c, fasting plasma glucose, serum insulin, homeostatic model assessment for insulin resistance, and serum triglycerides. Despite greater weight loss in the DJBL group (n = 23-30) at 26 to 50 weeks (10.4%-11.4%), the decrease in fasting plasma LEAP2 was delayed and attenuated (vs SMM), which may contribute to greater weight loss by attenuating GHSR signaling. Plasma LEAP2 did not increase with weight regain from 50 to 104 weeks after DJBL explant, suggesting a new set point with weight loss maintenance. Increases in plasma LEAP2 after a 600-kcal meal (10.8%-16.1% at 1-2 hours) were unaffected by weight loss, improved glucose metabolism, or DJBL insertion (n = 9-25), suggesting liver rather than duodenum/jejunum may be the primary source of postprandial LEAP2 secretion. Conclusion These findings add to our understanding of the regulation and potential physiological role of plasma LEAP2. [ABSTRACT FROM AUTHOR]

Blind loop syndrome (BLS) is a rare and significant gastrointestinal pathology, frequently associated with surgical interventions such as gastric bypass or intestinal resections. It manifests through the stagnation of intestinal contents, which promotes bacterial overgrowth and leads to malabsorption and nutritional deficiencies, especially in vitamins B12 and D. Symptoms include diarrhea, steatorrhea, abdominal pain, and neurological disturbances, such as subacute combined degeneration. The diagnosis requires a thorough clinical evaluation and advanced imaging studies. The management of BLS involves medical treatments, antibiotic therapy, surgical interventions to correct anatomical defects, and nutritional care to address underlying deficiencies. Severe complications include subacute combined degeneration, osteomalacia, and retroperitoneal hematoma. Patient education and prevention play essential roles in managing this condition. BLS presents a significant clinical challenge, requiring early diagnosis and effective therapeutic management to prevent complications and improve the quality of life for affected patients. This review explores the etiology, pathophysiology, diagnosis, and therapeutic options for BLS, highlighting the importance of a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Cytarabine (CTR) is a hydrophilic anticancer drug used to treat leukemia. It suffers from poor permeability and intestinal metabolism, diminishing its oral bioavailability. Background/Objectives: The objective was to develop and evaluate niosomes and bilosomes for enhanced intestinal absorption; hence, oral bioavailability. Results: CTR-loaded niosomes and bilosomes with vesicle sizes of 152 and 204.3 nm were successfully prepared with acceptable properties. The presence of bile salts increased the zeta potential of bilosomes. The recorded entrapment efficiency of cytarabine was acceptable for such a hydrophilic drug. CTR-bilosomes showed a pH-dependent drug release pattern with preferred release in pH 6.8. Intestinal absorption behavior indicated a site-dependent CTR absorption pattern with unfavorable absorption in the distal intestine. Niosomal and bilosomal formulations enhanced intestinal absorption parameters with evidence for a predominant paracellular absorption mechanism that bypasses intestinal barriers. The investigation of the anti-leukemic effect of niosomal and bilosomal formulations indicated that both formulations ameliorated the blood parameters, reflecting significant improvement in leukemia treatment compared with the drug solution. Pathological examination of blood films revealed decreased blast cells in peripheral blood in groups treated with tested formulations. Methods: Tested formulations were prepared according to the pro-concentrate method and characterized for particle size, zeta potential, entrapment efficiency, and in vitro release. CTR-loaded niosomes and bilosomes were evaluated for enhanced intestinal absorption utilizing the single-pass in situ intestinal perfusion method in rabbits, and the anti-leukemic effect was assessed using the benzene-induced leukemia model in rats. Conclusions: This study introduced surfactant vesicles for enhanced oral bioavailability of CTR. [ABSTRACT FROM AUTHOR]

Douglas abscesses (DA) involving the ovaries and/or fallopian tubes and tubo-ovarian abscesses (TOA) constitute a very rare finding in virginal females. Underlying conditions are suspected to play a role in their development; often however, the exact pathomechanism remains hypothetical or unknown. We report the case of a 19-year-old virginal female who was referred to our outpatient clinic for further clarification of a 6-month ongoing secondary amenorrhea. In the course of the investigations, a large Douglas abscess with distinctive bilateral salpingitis was diagnosed as an incidental finding in a basically oligosymptomatic patient. Laparoscopic abscess drainage was performed and appropriate antibiotic therapy administered. Intraoperatively collected specimens revealed Escherichia coli to be the responsible pathogen and detected foreign body giant cell reaction to intestinal contents on histopathological workup. Retrospectively, a small bowel perforation at the level of the jejunojejunostomy after Roux-en-Y gastric bypass with spillage of intestinal contents and positive cultures for Escherichia coli, 6 months prior to her referral, was identified as the triggering event. This case, however unique its pathomechanism may be, demonstrates that a history of intestinal leakage in the context of bowel surgery should be considered a relevant risk factor for the development of DA and TOA in virginal females, even if the primary cause lies several months in the past. It is under these circumstances that the clinical presentation can be atypical and misleading, making it all the more difficult to diagnose. Nonetheless, considering the possibility of this rare condition in light of medical history is crucial. [ABSTRACT FROM AUTHOR]

Summary: This study aimed to evaluate the efficacy and safety of duodenal–jejunal bypass liner (DJBL) for obesity and type 2 diabetes mellitus. A comprehensive search of electronic databases was conducted up to September 15, 2022. Thirty studies involving 1751 patients were included. At 12 months post‐implantation, the reduction in body mass index (BMI) was 4.8 kg/m2 (95% CI 4.1, 5.5), with an excess weight loss of 41.3% (95% CI 33.4%,49.2%) and a total weight loss of 13.1% (95% CI 10.1%, 16.0%). Significant decrease was observed in HbA1c and fasting glucose, with a standardized mean difference of − 0.72 (95% CI − 0.95, − 0.48) and − 0.62 (95% CI − 0.82, − 0.42), respectively. However, these improvements in weight loss and glycemic control were only partially sustained after explantation. In situ, DJBL significantly improves blood pressure and lipid levels. The pooled early removal rate was 19%, and the incidence of severe adverse events was 17%, including device migration (6%), gastrointestinal hemorrhage (4%), device obstruction (4%), and hepatic abscess (2%). DJBL offers significant improvement in weight loss and glycemic control, as well as cardiovascular parameters while in situ. Further studies are warranted to better understand the long‐term efficacy and safety of DJBL. The benefits of DJBL need to be carefully weighed against the risks in clinical decision‐making. [ABSTRACT FROM AUTHOR]

With the alarmingly increasing prevalence of obesity in the Western world, it has become necessary to provide more acceptable treatment options for patients with obesity. Minimally invasive endoscopic techniques are continuously evolving. Currently, metabolic and bariatric endoscopies encompass several different techniques that can offer significant weight loss and improvement in comorbidities with a favorable safety profile. Restrictive bariatric procedures include the use of intragastric balloons and gastric remodeling techniques with different suturing devices. Several studies have demonstrated the efficacy and safety of these techniques that are widely used in clinical practice. Small intestine-targeted metabolic endoscopy is an intriguing and rapidly evolving field of research, although it is not widespread in routine practice. These techniques include duodenal-jejunal bypass liners, duodenal mucosal resurfacing, and incisionless anastomoses. The aim of this review article is to provide a detailed update on the currently available bariatric endoscopy techniques in Western countries. [ABSTRACT FROM AUTHOR]

Background: Surgeries performed on the gastrointestinal system represent a significant caseload among small animal surgeries. Colostomy aims to temporarily or permanently divert the gastrointestinal tract but it is not commonly performed in veterinary medicine. Information regarding such procedures is scarce and the surgical technique is poorly described. Thus, the main objective of this study is to report a modified temporary colostomy performed in a dog after the development of rectocutaneous fistulas in the perineum as a surgical complication of unilateral perineal herniorrhaphy. Case Description: An 8-year-old male Lhasa Apso dog was attended due to the appearance of rectocutaneous fistulas with fecal content draining, as a complication of a recent perineal herniorrhaphy. A modified temporary colostomy was created by positioning the intestinal segment parallel to the lateral abdominal wall as a rescue procedure to allow healing of the perineum for later definitive repair of the hernia. Conclusion: The modified temporary colostomy allowed healing of the perineum by temporarily diverting the flow of fecal material. [ABSTRACT FROM AUTHOR]

This article provides guidelines for qualified surgeons on endoscopic surgery procedures related to the stomach. It focuses on laparoscopic surgery for conditions such as gastroduodenal ulcer perforation, gastric gastrointestinal stromal tumor (GIST), gastric cancer, and gastric/esophagogastric junction cancer. The guidelines discuss the outcomes, benefits, and risks of these procedures, emphasizing the need for further research and skilled supervision. The article also mentions the use of laparoscopic gastric restrictive surgery for improving quality of life in Stage I gastric cancer patients and recommends laparoscopic gastric restrictive surgery and robotic gastrectomy for severe obesity and gastric cancer, respectively. It emphasizes the importance of adhering to specific criteria and requirements when performing these procedures. [Extracted from the article]

The article discusses the increasing global incidence of bariatric surgeries, focusing on advancements in surgical techniques and the need for a new classification system to better categorize modern metabolic and bariatric procedures. The proposed parametric classification divides surgeries into resectional bariatric surgeries (RBS) and non-resectional bariatric surgeries (NRBS), further subcategorized based on anatomical focus and mechanisms of action. The classification aims to guide clinicians in selecting appropriate procedures tailored to individual health needs and anatomical contexts, emphasizing the importance of anatomical modifications over traditional restrictive or malabsorptive classifications. Additionally, the article highlights the relevance of resectional gastric bypass surgeries in high-risk gastric cancer populations and the necessity for further scientific validation of the classification to address associated risks effectively. [Extracted from the article]

Background: Diabetic cardiomyopathy is a serious complication of obesity with type 2 diabetes and is a major cause of mortality. Metabolic surgery, such as duodenal‐jejunal bypass (DJB), can effectively improve diabetic cardiomyopathy; however, the underlying mechanisms remain elusive. Oxidative stress is one of the pivotal mechanisms of diabetic cardiomyopathy. Our objective was to investigate the effect and potential mechanisms of DJB on oxidative stress in the heart of diabetic cardiomyopathy rats. Methods: High‐fat diet combined with intraperitoneal injection of streptozotocin was used to establish diabetic cardiomyopathy rats. DJB was performed on diabetic cardiomyopathy rats, and high glucose and palmitate were used to simulate diabetic cardiomyopathy in H9C2 cells in vitro. Sera from different groups of rats were used for experiments in vivo and in vitro. Results: DJB effectively improved oxidative stress and activated the adenosine monophosphate (AMP)‐activated protein kinase (AMPK) pathway to increase endothelial nitric oxide synthase (eNOS) phosphorylation level and the expression of antioxidative system‐related proteins and genes in the heart of diabetic cardiomyopathy rats. AMPK agonists and serum from DJB rats activated the AMPK pathway to increase eNOS phosphorylation level and the expression of antioxidative system‐related proteins and genes and decreased the content of reactive oxygen species in H9C2 cells, but this improvement was almost eliminated by the addition of AMPK inhibitors. Conclusions: DJB activates eNOS and enhances the antioxidant system by activating the AMPK pathway—and not solely by improving blood glucose—to improve oxidative stress in the heart of diabetic cardiomyopathy rats. [ABSTRACT FROM AUTHOR]

Chyloperitoneum (CP) is a rare complication after bariatric surgery. We present a 37‑year‑old female with CP caused by a bowel volvulus following a gastric clipping with proximal jejunal bypass for morbid obesity. An abdominal CT image of a mesenteric swirl sign and abnormal triglyceride level of ascites fluid can confirm the diagnosis. In this patient, laparoscopy demonstrated dilated lymphatic ducts caused by a bowel volvulus resulting in the exudation of chylous fluid into the peritoneal cavity. After the reduction of bowel volvulus, she made an uneventful recovery with complete resolution of the chylous ascites. The presence of CP could indicate a situation of small bowel obstruction in patients with a history of bariatric surgery. [ABSTRACT FROM AUTHOR]

The motility of the gastrointestinal tract is coordinated in part by rhythmic slow waves, and disrupted slow-wave patterns are linked to functional motility disorders. At present, there are no treatment strategies that primarily target slow-wave activity. This study assessed the use of pacing to suppress glucagon-induced slow-wave dysrhythmias in the small intestine. Slow waves in the jejunum were mapped in vivo using a high-resolution surface-contact electrode array in pigs (n = 7). Glucagon was intravenously administered to induce hyperglycemia. Slow-wave propagation patterns were categorized into antegrade, retrograde, collision, pacemaker, and uncoupled activity. Slow-wave characteristics such as period, amplitude, and speed were also quantified. Postglucagon infusion, pacing was applied at 4 mA and 8 mA and the resulting slow waves were quantified spatiotemporally. Antegrade propagation was dominant throughout all stages with a prevalence of 55 ± 38% at baseline. However, glucagon infusion resulted in a substantial and significant increase in uncoupled slow waves from 10 ± 8% to 30 ± 12% (P = 0.004) without significantly altering the prevalence of other slow-wave patterns. Slow-wave frequency, amplitude, and speed remained unchanged. Pacing, particularly at 8 mA, significantly suppressed dysrhythmic slow-wave patterns and achieved more effective spatial entrainment (85%) compared with 4 mA (46%, P = 0.039). This study defined the effect of glucagon on jejunal slow waves and identified uncoupling as a key dysrhythmia signature. Pacing effectively entrained rhythmic activity and suppressed dysrhythmias, highlighting the potential of pacing for gastrointestinal disorders associated with slow-wave abnormalities. NEW & NOTEWORTHY: Glucagon was infused in pigs to induce hyperglycemia and the resulting slow-wave response in the intact jejunum was defined in high resolution for the first time. Subsequently, with pacing, the glucagon-induced dysrhythmias were suppressed and spatially entrained for the first time with a success rate of 85%. The ability to suppress slow-wave dysrhythmias through pacing is promising in treating motility disorders that are associated with intestinal dysrhythmias. [ABSTRACT FROM AUTHOR]

Introduction: Duodenal-jejunal bypass (DJB) is an experimental procedure in metabolic surgery that does not have a restrictive component. Changes in bile acid (BA) dynamics and intestinal microbiota are possibly related to metabolic improvement after DJB. Our previous studies involving obese diabetic rats showed the crucial role of the biliopancreatic limb (BPL) in metabolic improvement after DJB caused by BA reabsorption. We established a new DJB procedure to prevent bile from flowing into the BPL and aimed to elucidate the importance of bile in the BPL after DJB. Methods: Otsuka Long-Evans Tokushima Fatty rats with diabetes were divided into three groups: two DJB groups and a sham group (n = 11). Duodenal-jejunal anastomosis was performed proximal to the papilla of Vater in the DJB group (n = 11). However, the DJB-D group (n = 11) underwent a new procedure with duodenal-jejunal anastomosis distal to the papilla of Vater for preventing bile flow into the BPL. Results: Glucose metabolism improved and weight gain was suppressed in the DJB group, but not in the DJB-D and sham groups. Serum BA level and conjugated BA concentration were elevated in the DJB group. The gut microbiota was altered only in the DJB group; the abundance of Firmicutes and Bacteroidetes decreased and that of Actinobacteria increased. However, the DJB-D group exhibited no apparent change in the gut microbiota, similar to the sham group. Conclusion: BAs are essential in the BPL for metabolic improvement after DJB; they can improve the gut microbiota in these processes. [ABSTRACT FROM AUTHOR]

Background: Superior mesenteric artery (SMA) syndrome is a rare cause of small bowel obstruction due to extrinsic compression of the duodenum. This study aimed to evaluate the presentation, surgical management, and outcomes of seven patients with SMA syndrome treated at two tertiary care centers in India between June 2015 and January 2023.All patients presented with chronic vomiting, nausea, epigastric pain, and weight loss. Diagnosis was confirmed by radiological findings, including CT scans demonstrating a narrowed aortomesenteric angle (<22 degrees) and dilated proximal duodenum. Surgical intervention was the mainstay of treatment due to minimal success with non-operative management. All patients except one underwent laparoscopic duodenojejunostomy. One patient with a post-operative stricture required conversion to a Roux-en-Y duodenojejunostomy. Methods: We have managed seven cases of duodenal obstruction due to SMA syndrome during the time period of June 2015 to January 2023. The study included cases pooled from two tertiary care centers of Andhra Pradesh. The primary evaluation was done by gastroenterologists, psychologists and followed by detailed surgical evaluation. Ultrasonography and upper endoscopy were done for all cases followed by CT scan of the abdomen in all the cases. All the patients had clinical and radiological findings consistent with SMA syndrome. Data collected included patient demographics, clinical presentation, operative data, and outcomes. Data are presented as mean ± standard deviation for continuous variables and as percentages for categorical variables. Results: The seven patients included 5females and 2 males (female to male ratio was 2.5:1). The mean age of the cases was 21.29 ± 4.15 years (range 13 - 26 years). The Comorbidities identified in these cases included Psychiatric/anxiety (14.29%), anorexia (28.57%), Pancreatitis (14.29%), Mild scoliosis (14.29%), Binge/fasting (14.29%). No clear reason was identified in one case (14.29%) and attributed to fibromyalgia. One patient had previous laparoscopic appendicectomy, but no other patient had any history of abdominal or spinal surgery. [ABSTRACT FROM AUTHOR]

OBJECTIVES Intestinal ischaemia–reperfusion injury induced by cardiopulmonary bypass causes intestinal epithelial barrier dysfunction, leading to dysbiosis and bacterial translocation. We conducted a randomized prospective study with 2 objectives: (i) to investigate epithelial barrier dysfunction and bacterial translocation induced by cardiopulmonary bypass and changes in the gut microbiota and (ii) to verify whether probiotics can improve these conditions. METHODS Between 2019 and 2020, patients 0–15 years old scheduled to undergo cardiac surgery using cardiopulmonary bypass were enrolled and randomly allocated to 2 groups: the intervention group received probiotics and the control group did not receive probiotics. We analysed the microbiota in faeces and blood, organic acid concentrations in faeces, plasma intestinal fatty acid-binding protein and immunological responses. RESULTS Eighty-two patients were enrolled in this study. The characteristics of the patients were similar in both groups. The total number of obligate anaerobes was higher in the intervention group than in the control group after postoperative day 7. We identified 4 clusters within the perioperative gut microbiota, and cluster changes showed a corrective effect of probiotics on dysbiosis after postoperative day 7. Organic acid concentrations in faeces, incidence of bacterial translocation, intestinal fatty acid-binding protein levels and immunological responses, except for interleukin -17A, were not markedly different between the 2 groups. CONCLUSIONS Administration of probiotics was able to correct dysbiosis but did not sufficiently alleviate the intestinal damage induced by cardiopulmonary bypass. More effective methods should be examined to prevent disturbances induced by cardiac surgery using cardiopulmonary bypass. Clinical trial registration number https://center6.umin.ac.jp/cgi-open-bin/ctr%5fe/ctr%5fview.cgi?recptno=R000037174 UMIN000035556 [ABSTRACT FROM AUTHOR]

Beyond the direct benefit that a transplanted organ provides to an individual recipient, the study of the transplant process has the potential to create a better understanding of the pathogenesis, etiology, progression and possible therapy for recurrence of disease after transplantation while at the same time providing insight into the original disease. Specific examples of this include: 1) recurrence of focal segmental glomerulosclerosis (FSGS) after kidney transplantation, 2) recurrent autoimmunity after pancreas transplantation, and 3) recurrence of disease after orthotopic liver transplantation (OLT) for cirrhosis related to progressive steatosis secondary to jejuno-ileal bypass (JIB) surgery. Our team has been studying these phenomena and their immunologic underpinnings, and we suggest that expanding the concept to other pathologic processes and/or transplanted organs that harbor the risk for recurrent disease may provide novel insight into the pathogenesis of a host of other disease processes that lead to organ failure. [ABSTRACT FROM AUTHOR]

Background: Bilious vomiting in a child potentially portends the dire emergency of intestinal malrotation with volvulus, necessitating prompt surgical management, with differentials including small-bowel atresia, duodenal stenosis, annular pancreas, and intussusception. Although the upper-gastrointestinal series (UGI) is the diagnostic investigation of choice, up to 15% of the studies are inconclusive, thereby posing a diagnostic challenge. Case Reports: We report a case series of 3 children referred for bilious vomiting, whose initial UGI was inconclusive and who were eventually confirmed to have intestinal malrotation at surgery. The first child was a female born at 37 weeks with antenatally diagnosed situs inversus and levocardia, who developed bilious vomiting on day 1 of life. The duodenojejunal flexure (DJ) could not be visualized on the UGI because of faint opacification on first pass of the contrast and subsequent overlap with the proximal jejunal loops. The second child was a male born at 36 weeks, presenting at age 4 months with bilious vomiting of 2 days duration. The third child was a female born at 29 weeks, presenting with bilious aspirates on day 3 of life. UGI for all 3 showed persistent hold-up of contrast at the proximal duodenum with no opacification of the distal duodenum or small bowel. Adjunctive techniques during the UGI and ultrasound examination helped achieve a preoperative diagnosis of malrotation in these children. Conclusions: Application of diagnostic adjuncts to an inconclusive initial UGI may help elucidate a preoperative diagnosis of intestinal malrotation in infantile bilious vomiting. [ABSTRACT FROM AUTHOR]

Background: Esophageal squamous cell carcinoma is characterized by field cancerization, wherein multiple cancers occur in the esophagus, head and neck, and stomach. Synchronous esophageal and colorectal cancers are also encountered with a certain frequency. A good prognosis can be expected if the tumors in both locations can be safely and completely removed. For patients with multiple cancers that occur simultaneously with esophageal cancer, it is necessary to perform a staged operation, taking into consideration the associated surgical invasiveness. It is also necessary to select multidisciplinary treatment depending on the degree of progression of the multiple lesions. We report our rare experience with a staged operation for a patient with synchronous advanced cancers of the esophagus and cecum who had previously undergone total gastrectomy with reconstruction by jejunal interposition for gastric cancer. Case presentation: A 71-year-old man with a history of reconstruction by jejunal interposition after total gastrectomy was diagnosed as having multiple synchronous esophageal and cecal cancers. After neoadjuvant chemotherapy, we performed a planned two-stage operation, with esophagectomy and jejunostomy in the first stage and ileocecal resection and jejunal reconstruction with vascular anastomosis in the second. Postoperatively, the patient was relieved without major complications, and both tumors were amenable to curative pathologic resection. Conclusions: Our procedure reported here may be recommended as an option for staged resection and reconstruction in patients with simultaneous advanced esophageal and cecal cancer after total gastrectomy. [ABSTRACT FROM AUTHOR]

Increased survival of patients undergoing total gastrectomy for gastric cancer has prompted several efforts to improve long-term postgastrectomy syndrome (PGS) outcomes. Whether a J-pouch (JP) reconstruction may be more beneficial than a standard Roux-en-Y (RY) is controversial. A systematic review with meta-analysis was conducted, including studies reporting long-term outcomes of patients treated with total gastrectomy and JP vs RY esophagojejunostomy for gastric adenocarcinoma. A literature search was performed on PubMed, Scopus, and Google Scholar. Primary endpoints were symptom control, weight loss, eating capacity (EC), and quality of life (QoL) with at least 6 months of follow-up. Safety endpoints were explored. Overall, 892 patients were included from 15 studies (6 randomized controlled trials [RCTs] and 9 non-RCTs): 452 (50.7%) in the JP group and 440 (49.3%) in the RY group. Compared with RY, JP showed a significantly lower rate of dumping syndrome (13.8% vs 26.9%, odds ratio [OR], 0.29; 95% confidence interval [CI], 0.14-0.58; P <.001; I 2 = 22%) and heartburn symptoms (20.4% vs 39.0%; OR, 0.29; 95% CI, 0.14-0.64; P =.002; I 2 = 0%). Reflux (OR, 0.61; 95% CI, 0.28-1.32; P =.21; I 2 = 42%) and epigastric fullness (OR, 0.60; 95% CI, 0.18-2.05; P =.41; I 2 = 69%) were similar in both groups. Weight loss and EC were similar between the groups. QoL outcome seemed to be burdened by bias. There was no difference in morbidity, mortality, and anastomotic leak rate between groups. Operative time was significantly longer for JP than for RY (271.9 vs 251.6 minutes, respectively; mean difference, 21.55; 95% CI, 4.64-38.47; P =.01; I 2 = 96%). JP reconstruction after total gastrectomy for gastric cancer is as safe as RY and may provide an advantage in postgastrectomy dumping syndrome and heartburn symptoms. [ABSTRACT FROM AUTHOR]

Background: Although endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using lumen-apposing metal stents (LAMS) has become one of the treatments of choice for acute cholecystitis (AC) in fragile patients, scant data are available on real-life settings and long-term outcomes. Methods: We performed a multicenter retrospective study including EUS-guided GBD using LAMS for AC in 19 Italian centers from June 2014 to July 2020. The primary outcomes were technical and clinical success, and the secondary outcomes were the rate of adverse events (AE) and long-term follow-up. Results: In total, 116 patients (48.3% female) were included, with a mean age of 82.7 ± 11 years. LAMS were placed, transgastric in 44.8% of cases, transduodenal in 53.3% and transjejunal in 1.7%, in patients with altered anatomy. Technical success was achieved in 94% and clinical success in 87.1% of cases. The mean follow-up was 309 days. AEs occurred in 12/116 pts (10.3%); 8/12 were intraprocedural, while 1 was classified as early (<15 days) and 3 as delayed (>15 days). According to the ASGE lexicon, two (16.7%) were mild, three (25%) were moderate, and seven (58.3%) were severe. No fatal AEs occurred. In subgroup analysis of 40 patients with a follow-up longer than one year, no recurrence of AC was observed. Conclusions: EUS-GBD had high technical and clinical success rates, despite the non-negligible rate of AEs, thus representing an effective treatment option for fragile patients. [ABSTRACT FROM AUTHOR]

Purpose: Metabolic surgery remains underutilized for treating type 2 diabetes, as less invasive alternative interventions with improved risk profiles are needed. We conducted a pilot study to evaluate the feasibility of a novel magnetic compression device to create a patent limited caliber side-to-side jejunoileal partial diversion in a nonhuman primate model. Materials and Methods: Using an established nonhuman primate model of diet-induced insulin resistance, a magnetic compression device was used to create a side-to-side jejunoileal anastomosis. Primary outcomes evaluated feasibility (e.g., device mating and anastomosis patency) and safety (e.g., device-related complications). Secondary outcomes evaluated the device's ability to produce metabolic changes associated with jejunoileal partial diversion (e.g., homeostatic model assessment of insulin resistance [HOMA-IR] and body weight). Results: Device mating, spontaneous detachment, and excretion occurred in all animals (n = 5). There were no device-related adverse events. Upon completion of the study, ex vivo anastomoses were widely patent with healthy mucosa and no evidence of stricture. At 6 weeks post-device placement, HOMA-IR improved to below baseline values (p < 0.05). Total weight also decreased in a linear fashion (R2 = 0.97) with total weight loss at 6 weeks post-device placement of 14.4% (p < 0.05). Conclusion: The use of this novel magnetic compression device to create a limited caliber side-to-side jejunoileal anastomosis is safe and likely feasible in a nonhuman primate model. The observed glucoregulatory and metabolic effects of a partial jejunoileal bypass with this device warrant further investigation to validate the long-term glucometabolic impact of this approach. [ABSTRACT FROM AUTHOR]

Background: To investigate the feasibility of a deformable self-assembled magnetic anastomosis ring (DSAMAR), designed and developed by us, for endoscopic gastrointestinal bypass anastomosis. Methods: Ten experimental pigs were used as model animals. The DSAMAR comprises 10 trapezoidal magnetic units, arranged in a straight line under the constraint of a guide wire. When the desired anastomosis site is reached under the guidance of an endoscope, the catheter pushes the magnetic unit along the guide wire. The linear DSAMAR can be assembled into a circular DSAMAR. Two DSAMARs were inserted, one at the end of the duodenum and the other into the stomach successively. They attracted each other and compressed the wall of the stomach and duodenum to establish gastrointestinal bypass anastomosis. The experimental pigs were euthanized 4 weeks after the operation, and the gastrointestinal bypass anastomosis specimens were obtained. The anastomosis formation was evaluated by the naked eye and histology. Results: Gastrointestinal bypass anastomosis with DSAMARs was successfully performed. The average operation time under an endoscope was 70.30 ± 19.05 min (range: 43–95 min). The DSAMARs were discharged through the anus 10–17 days after surgery. There were no complications such as gastrointestinal bleeding, perforation, anastomotic fistula, and gastrointestinal obstruction during and after the operation. Gastroscopy and gross specimen of the anastomosis showed a well-formed magnetic anastomosis. Histological observation showed good continuity of the serous membrane and the mucosa of magnetic anastomosis. Conclusion: The DSAMAR is a safe and feasible device for fashioning gastrointestinal bypass anastomosis in this animal model. [ABSTRACT FROM AUTHOR]

Introduction: Sleeve gastrectomy with jejunal bypass (SGJB) has been used as a bariatric/metabolic procedure since 2003, in the search for a simpler than other standard techniques and as effective as them. The jejunal–ileal anastomosis can deliver food directly to the hindgut where incretins are secreted. This procedure has gained popularity around the globe and has been studied in rat models as in humans, especially in South America and Asia. In this review, we present the details of the original surgical technique SGJB, summarized all the publications of the procedure, discuss possible advantages and disadvantages, and provide scientific information to look for the real place between bariatric/metabolic procedures. Methods: With 20 years of experience performing the original SGJB, the authors present the details of the procedure. Results: The SGJB consists of a traditional sleeve with the addition of a jejunal bypass. The jejunum is transected 20–30 cm distally to the ligament of Treitz. Then, the biliopancreatic limb is anastomosed to restore transit 250–300 cm distal to the jejunum transection. This way, the ileum gets in contact with partially digested food with the subsequent production of incretins. Conclusion: In this article, we describe the original Alamo technique of SGJB. It is important to clarify the technical details since many publications have presented different lengths of the defunctionalized jejunal limb. Also, the SGJB has been categorized in the "sleeve plus" procedures and its promising outcomes should rapidly position it as an alternative metabolic surgery. [ABSTRACT FROM AUTHOR]

Background: We previously described sleeve gastrectomy with jejunoileal bypass (SGJIB) as promising novel technique for the surgical treatment of obesity Methods: A retrospective analysis of a prospective database in a Private Practice of Alimentary Tract Surgery in São Paulo, Brazil. We analyzed 176 patients with 60 months of follow-up, 74 of whom underwent Vertical Sleeve Gastrectomy with Jejunoileal Bypass (VSG-JIB) (50 women and 24 men) with a mean age of 38 years and a mean body mass index (BMI) of 40 kg/m2, and 102 patients underwent Roux-en-Y gastric bypass (RYGB) (90 women and 12 men) with a mean age of 36.5 years and a mean BMI of 39.73 kg/m2. Results: There was no statistically significant difference in long-term weight loss between the two groups. The rate of postoperative complications immediately after surgery was similar, but there was a tendency toward less severe complications in the SGJIB cohort. Conclusion: Sleeve gastrectomy with jejunoileal bypass is a novel surgical procedure for weight loss with comparable efficacy and safety compared with laparoscopic RYGB. [ABSTRACT FROM AUTHOR]

Purpose: There are only a few case reports of laparoscopic lateral duodenojejunostomy (LLDJ) in children with Wilkie's syndrome, also known as superior mesenteric artery compression syndrome (SMAS). We aimed to describe our laparoscopic technique and evaluate its outcomes for SMAS in children. Methods: From January 2013 to May 2021, SMAS children who received LLDJ were included. The procedure was carried out utilizing the four-trocar technique. The elevation of the transverse colon allows good exposure of the dilated and bulging second and third sections of the duodenum. Using a linear stapler, we established a lateral anastomosis connecting the proximal jejunum with the third part of the duodenum. Following that, a running suture was used to intracorporeally close the common enterotomy. Clinical data on patients was collected for analysis. The demographics, diagnostic findings, and postoperative outcomes were analyzed retrospectively. Results: We retrospectively analyzed 9 SMAS patients (6 females and 3 males) who underwent LLDJ, aged between 7 and 17 years old. The mean operative time was 118.4 ± 16.5 min and the mean estimated blood loss was 5.6 ± 1.4 ml. There were no conversion, intraoperative complications or immediate postoperative complications. The mean postoperative hospital stay was 6.8 ± 1.9 days and the mean follow-up time was 5.4 ± 3.0 years. During follow-up, seven patients (77.8%) experienced complete recovery of symptoms prior to surgery. One patient (11.1%) still had mild vomiting, which resolved with medication. Another patient (11.1%) developed psychological-induced nausea, which significantly improved after treatment with education, training and diet management. Conclusions: LLDJ represents a feasible and safe treatment option for SMAS in well-selected children. Further evaluation with more cases and case-control studies is required for the real benefits. [ABSTRACT FROM AUTHOR]

We report a case of a second free jejunal transfer to treat metastasis in the mesenteric lymph node of the first jejunal flap. A 73-year-old man underwent total pharyngolaryngectomy, bilateral neck dissection, and free jejunal transfer for recurrent hypopharyngeal cancer [left pyriform sinus, pT2N0, moderately differentiated squamous cell carcinoma (SCC)] after radiotherapy. Seven years post-surgery, he underwent transoral videolaryngoscopic surgery for oropharyngeal cancer (soft palate, pT1N0, well-differentiated SCC). Ten years after the first jejunal transfer, metastasis was found in the mesenteric lymph node surrounding the jejunal flap's vascular pedicle. Under general anesthesia, resection of the first jejunum including the affected lymph node, and second jejunal transfer were performed. Lymph node pathological examination revealed poorly differentiated SCC, compatible with pharyngeal cancer metastasis. After neck dissection and jejunal flap transfer, lymphatic collateral pathways toward the flap's mesenteric lymph node might form. Possibly, hypopharyngeal or oropharyngeal cancer metastasized via this pathway. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the impact of genotypes and tannin levels on the nutritional characteristics of faba bean seeds and their relation to protein molecular structure profiles using Fourier transform infrared spectroscopy (FTIR). Eight genotypes with low tannin (LT, n = 3) and normal tannin (NT, n = 5) levels were studied. Standard methods of analysis and NRC 2001 were used to obtain chemical and energy parameters. The protein molecular spectral study was performed using a spectrometer JASCO FT/IR–4200. Molecular features were analyzed in the mid-infrared region at ∼4000–800 cm−1 and protein-related functional groups were obtained using OMNIC software. Results showed higher (P < 0.01) soluble crude protein (SCP), rapidly degradable protein fraction (PA2), and intestinal digestibility of bypass protein (dIDP) in LT than NT. The slowly degradable protein fraction (PB2) was higher in NT (P < 0.01) compared to LT. Higher absorbance was observed in spectral peaks related to amide I, amide II, and β-sheet in NT (P < 0.05) compared to LT. The area ratio of amide I to amide II and the height ratio of α-helix to β-sheet were higher in LT compared to NT (P < 0.01). This study provides a better understanding of associations between structure and nutritional characteristics in faba bean genotypes with different tannin levels. [ABSTRACT FROM AUTHOR]

Background/Purpose: Whether Roux-en-Y hepatic jejunectomy (HJ) or duct-to-duct biliary reconstruction (DD) is more useful in pediatric living donor liver transplantation has not yet been fully investigated. Therefore, to assess the feasibility and safety of DD, we compared the surgical outcomes of DD to HJ. Methods: We divided 45 patients, excluding those with biliary atresia, into the DD group (n = 20) and the HJ group (n = 25), according to the type of biliary reconstruction they received. Results: The 5-year survival rates (DD vs. HJ = 79.7% vs. 83.6%, p = 0.70) and the incidence of biliary complications, including bile leakage and stricture (DD vs. HJ = 1 [5.0%] vs. 1 [4.0%], p = 0.87) were not significantly different between the groups. However, intestinal complications, including bowel perforation or ileus, were significantly common in the HJ group (9/25 [36.0%]) than in the DD group (1/20 [5.0%]; p = 0.01). The three patients in the HJ group with intestinal perforation all suffered perforation at the anastomosed site in the Roux-en-Y procedure. The subgroup analysis showed the non-inferiority of DD to HJ for biliary or intestinal complications in patients weighting < 10 kg. Conclusion: With a proper selection of cases, DD should be a safe method for biliary reconstruction in pediatric recipients with little risk of biliary complications equivalent to HJ and a reduced risk of intestinal complications. [ABSTRACT FROM AUTHOR]

This article presents a study on duodenal perforations caused by nasojejunal tubes, which are often used for temporary enteral nutrition. The study examined data from multiple centers and identified five patients who experienced perforations related to these tubes. The perforations were confirmed through computed tomography or endoscopy. The patients were treated based on the severity of their symptoms and all were asymptomatic during follow-up. The article includes specific cases of patients who suffered duodenal perforations and discusses the management and outcomes of each case. Additionally, the document discusses a case study involving a 19-year-old woman who experienced a duodenal perforation after the placement of a nasojejunal tube. Nasojejunal tubes are commonly used for temporary nutrition and can be placed blindly at the bedside or with the guidance of endoscopy or fluoroscopy. However, blind placement has a high failure rate, while endoscopic and fluoroscopic methods have shown greater success. The study suggests that selecting the appropriate tube and closely monitoring patients receiving tube feeding can help reduce the risk of complications. [Extracted from the article]

Background: Enteral drug therapy is challenging in short bowel syndrome with intestinal failure (SBS‐IF) because of unpredictable absorption. SEFA‐6179 is an enterally administered medium‐chain fatty acid analogue under development for intestinal failure–associated liver disease. We investigate the pharmacokinetics of two SEFA‐6179 formulations in two large‐animal models of SBS‐IF, including a new pseudojejunostomy model. Methods: Twenty Yucatan minipigs were obtained. Half underwent pre‐resection pharmacokinetic study with single‐dose SEFA‐6179 administration. All minipigs then underwent 90% jejunoileal resection, with either a jejunoileal anastomosis or bypass of the intraperitoneal colon with anastomosis just proximal to the rectum (pseudojejunostomy). On postoperative day 3, a single‐dose pharmacokinetic study was performed. Results: Both SBS‐IF models were well tolerated. Compared with the jejunoileal anastomosis minipigs, pseudojejunostomy minipigs had a more severe malabsorptive phenotype with weight loss by postoperative day 4 (+0.1 vs −0.9 kg, P = 0.03) and liquid diarrhea (Bristol 5 vs Bristol 7, P = 0.0007). Compared with pre‐resection minipigs, both jejunoileal and pseudojejunostomy minipigs had lower total plasma exposure of SEFA‐6179 measured by area under the curve (jejunoileal: 37% less, P = 0.049; pseudojejunostomy: 74% less, P = 0.0001). Peak plasma concentration was also lower in the pseudojejunostomy group compared with pre‐resection (65% less, P = 0.04), but not lower in the jejunoileal group (P = 0.47). Conclusion: In two SBS‐IF minipig models, SEFA‐6179 had substantially decreased absorption compared with pre‐resection minipigs. Dose optimization for different intestinal anatomy and function may be required. We describe a new SBS‐IF pseudojejunostomy model that may improve the translation of preclinical research to patients with SBS‐IF who have enterostomies. [ABSTRACT FROM AUTHOR]

Since its inception in the early 1970s, bariatric surgery has experienced remarkable advancements, leading to improved patient outcomes. However, amidst these developments, the once-popular ileojejunal bypass procedure has faded into obscurity, along with its associated risks and complications. In this particular case, we present the medical history of a 68-year-old male who endured prolonged hospitalization due to a myriad of health issues, including malnutrition, kidney stones, chronic kidney disease, and persistent diarrhea following an ileojejunal bypass performed back in 1973. Troublingly, his symptoms were erroneously attributed to other causes for an extended period, overlooking the potential long-term effects of his prior surgery. This case emphasizes the importance of recognizing and monitoring the lasting impacts of historical surgical interventions, as well as the need for heightened vigilance in postoperative care. [ABSTRACT FROM AUTHOR]

Introduction: Free jejunal flap (FJF) reconstruction is a standard procedure for pharyngeal and cervical esophageal defects resulting from head and neck cancer resection. However, improvements in patients' quality of life after surgery require a further statistical approach. Methods: An observational, retrospective, multivariate analysis was designed to report the incidence of postoperative complications and their association with clinical factors in 101 patients who underwent total pharyngo-laryngo-esophagectomy and FJF reconstruction for head and neck cancer at a university hospital between January 2007 and December 2020. Results: Postoperative complications were observed in 69% of patients. In the reconstructive site, anastomotic leak, observed in 8% of patients was associated with vascular anastomosis in the external jugular vein system (age-adjusted odds ratio [OR]: 9.05, p = 0.044) and anastomotic stricture, observed in 11% of patients was associated with postoperative radiotherapy (age-adjusted OR: 12.60, p = 0.02). Cervical skin flap necrosis was the most common complication (34%) and was associated with vascular anastomosis on the right cervical side (age- and sex-adjusted OR: 4.00, p = 0.005). Conclusion: Although FJF reconstruction is a useful procedure, 69% of patients suffer a postoperative complication. We suppose that anastomotic leak is related to the low blood flow resistance of the FJF and inadequate drainage of the external jugular venous system, and anastomotic stricture is related to the vulnerability of the intestinal tissue to radiation. Furthermore, we hypothesized that the location of the vascular anastomosis may affect the mesenteric location of the FJF and the dead space in the neck, leading to the development of cervical skin flap necrosis. These data contribute to increasing our knowledge about postoperative complications related to FJF reconstruction. [ABSTRACT FROM AUTHOR]

Background: The current design of biliopancreatic diversion with duodenal switch (BPD/DS) and single anastomosis duodenal–ileal bypass with sleeve (SADI-S) emphasizes the importance of the pylorus' preservation to reduce the incidence of marginal ulcer (MU) and dumping. However, no institutional studies have yet reported data on their prevalence. We aimed to assess the incidence of MU and dumping after duodenal switch (DS) and identify the associative factors. Methods: A multi-center review of patients who underwent BPD/DS or SADI-S between 2008 and 2022. Baseline demographics, symptoms, and management of both complications were collected. Fisher's exact test was used for categorical variables and the independent t-test for continuous variables. Results: A total of 919 patients were included (74.6% female; age 42.5 years; BMI 54.6 kg/m2) with mean follow-up of 31.5 months. Eight patients (0.9%) developed MU and seven (0.8%) had dumping. Patients who developed MU were more likely to be using non-steroidal anti-inflammatory drugs (NSAID) (p = 0.006) and have a longer operation time (p = 0.047). Primary versus revisional surgery, and BDP/DS versus SADI-S were not associated with MU or dumping. Conclusions: The incidences of MU and dumping after DS were low. NSAID use and a longer operation time were associated with an increased risk of MU, whereas dumping was attributed to poor dietary habits. [ABSTRACT FROM AUTHOR]

Gastrojejunostomy without gastric resection is performed to bypass the distal stomach or the duodenum. Gastrojejunal stoma (GJ) obstruction is an unusual complication. Pancreatic injuries are usually subtle to identify by different diagnostic imaging modalities or intraoperatively, as the classic features are absent during the first 24 h and even for several days. Symptoms of injury to other intra-abdominal organs or structures commonly mask or supersede that of pancreatic injury, both early and late in the course of trauma. Hence, these injuries are often overlooked. We present a case of gastrojejunal stoma obstruction after a primary repair of traumatic American Association for the Surgery of Trauma" (AAST) grade IV duodenal injury. The surgery included repair of the duodenum over a T-tube, a pyloric occlusion, a retrocolic loop gastrojejunostomy, and feeding jejunostomy. And thereafter, successful management of postoperative complication with adhesiolysis, necrosectomy, and revised antecolic isoperistaltic Roux-en-Y gastrojejunostomy for retrocolic GJ stoma obstruction due to post-traumatic pancreatitis. [ABSTRACT FROM AUTHOR]

Background: Small bowel cancer (SBC) is a rare malignancy that is often diagnosed at an advanced stage. Palliative chemotherapy is the standard treatment for patients with metastatic SBC. The relevant literature on conversion surgery in patients who have responded favorably to chemotherapy is limited. Case presentation: A 64-year-old man was diagnosed with jejunal carcinoma with multiple peritoneal metastases. After implanting an expandable metallic stent at the primary site, the patient underwent 6 months of FOLFOX therapy, resulting in a clinical complete response. Chemotherapy was continued, and four years after the initiation of therapy, the patient showed no evidence of disease progression. Nevertheless, anemia of continuous minor hemorrhages from the stent site and general malaise of chemotherapy got progressively worse during treatment. After confirming negative ascites cytology and the absence of peritoneal metastasis via staging laparoscopy, the patient underwent partial jejunectomy. Pathologically, no residual tumor was detected in the resected specimen. The postoperative course was uneventful, and the patient remained free of recurrence for 30 months after surgery without chemotherapy. Conclusion: Although infrequent, conversion surgery may be a valid therapeutic option for selected cases of SBC with peritoneal metastasis. [ABSTRACT FROM AUTHOR]

Unknown intestinal rotation anomaly poses a challenge in laparoscopic gastric bypass surgery. We present a case of a patient with intestinal non-rotation that stayed undetected throughout performing a laparoscopic Roux-en-Y gastric bypass. As a result, the alimentary limb was constructed in an anti-peristaltic way, and the whole gastric bypass was located far more distally than usual. Postoperatively, the patient presented with recurring nausea and vomiting. After several diagnostic steps, a computed tomography finally revealed the inadvertently reverse directed gastric bypass and the pre-existing condition of intestinal non-rotation. This was followed by a diagnostic laparoscopy and the reconstruction of the gastric bypass in "mirrored" technique. [ABSTRACT FROM AUTHOR]

Like all surgical fields, bariatric surgery has evolved immensely, so much so that previous procedures are now obsolete. For instance, the jejunoileal bypass has fallen out of favor after severe metabolic consequences resulted in prolonged morbidity and even mortality. Despite this, several patients persevered long enough to develop other pathology, such as cancer. This progression has been validated in animal models but not human patients. Nonetheless, contemporary surgeons may encounter situations where they must resect and re-establish intestinal continuity in patients with this antiquated anatomy. When faced with this scenario, the question of whether or not the previously bypassed small bowel can be safely reunited plagues the surgeon remains unanswered. Unfortunately, the literature does not effectively answer this question, even anecdotally through case reports or series. Therefore, we share our experience with three patients who developed colon cancer following jejunoileal bypass and subsequently underwent oncologic resection with simultaneous reversal of their jejunoileal bypasses.

The article discusses a recent statement released by the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) regarding innovative bariatric procedures and ethical guidelines. The author criticizes the statement for its flaws, including incomplete citations, confounding factors, and emotional expression, which caused confusion in the field of bariatric surgery. The author suggests that the focus of the statement should have been on standardizing and promoting bariatric surgery, rather than evaluating procedures from a moral and ethical perspective. The article also highlights the importance of accurate and comprehensive access to information when researching and citing references on innovative techniques. The author concludes by emphasizing the need for academic organizations like IFSO to be more scientific, inclusive, and authoritative in their statements. [Extracted from the article]

This document, published in the journal CardioVascular & Interventional Radiology, discusses a technique called the Crossing Sword Technique for stabilizing the jejunum during percutaneous jejunostomy. Jejunostomy tubes are used to provide enteral nutritional support to patients who cannot undergo percutaneous gastrostomy. However, percutaneous jejunostomy can be challenging due to the mobility of the jejunum. The Crossing Sword Technique involves using multiple 22-gauge needles to immobilize the jejunum and facilitate catheter placement. The technique has been found to be particularly useful in patients without a prior history of surgically placed jejunostomy tubes. [Extracted from the article]

The article discusses the revision of Laparoscopic Roux-en-Y Gastric Bypass to Laparoscopic Sleeve Gastrectomy with Proximal Jejunal Bypass and Hiatal Hernia Repair as a safe and feasible procedure for patients experiencing post-surgical complications such as dumping syndrome or malabsorption. The case study presented involves a 51-year-old female who developed dumping syndrome after an initial LRYGB procedure, leading to abdominal pain, diarrhea, and other symptoms. The revision surgery to LSGPJB was successful, resulting in the remission of dumping syndrome and other complications. The article emphasizes the effectiveness of this revision procedure for addressing post-LRYGB complications. [Extracted from the article]

Background: One Anastomosis Gastric Bypass is one of the commonest bariatric surgeries worldwide, which has been demonstrated to produce excellent bariatric and metabolic outcomes. Single Anastomosis Sleeve Jejunal Bypass is a novel procedure that was developed in Hazrat e Rasool Hospital by Pazouki and Kermansavari in 2019 to form an anastomosis between the sleeved stomach and the jejunum rather than the ileum as a modification of the previously known SASI. Objective: To compare the outcome of SASJ with OAGB as regards efficacy and safety in a 6-month postoperative follow up period. Patients and Methods: This was a comparative prospective randomized study conducted in Ain Shams University Hospitals, over 40 patients devided into 2 groups. First group was composed of 20 patients who underwent SASJ operation, and second group was composed of 20 patients who underwent OAGB operation. Results: The mean excess weight loss percentage after 6 months of SASJ group of patients was 51.55% ± 15.11, and 58.30% ± 24.32 in OAGB group. Both groups showed excellent outcomes as regards comorbidities resolution. In OAGB group, there was 1 patient who had postoperative bleeding. In SASJ group, we had one case of reflux alkaline gastritis that needed readmission. In addition, we had one case (5%) that needed reoperation and conversion to Roux-en Y configuration. In SASJ group, there were 7 patients complained from bile reflux, and 3 patients in OAGB group. In SASJ group of patients we had only 1 patient who developed postoperative gall bladder stones, and 6 patients in OAGB group. Conclusion: Both OAGB and SASJ are effective bariatric procedures as regards weight loss and comorbidities resolution such as DM, HTN and hyperlipidemia. Incidence of biliary reflux was found more among the SASJ patients, but it was almost overcomed after performing the antireflux suture. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the feasibility and efficacy of simultaneous resection of synchronous advanced esophageal and gastric cancers. Methods: We retrospectively analyzed the clinical data of 16 patients who underwent resection of synchronous advanced esophageal squamous cell carcinoma (ESCC) and gastric adenocarcinoma from January 2009 to Dec 2021. Subtotal esophagectomy and total gastrectomy were performed using the Ivor-Lewis or McKeown approach. Reconstruction was performed using a pedicled jejunal graft or colon interposition. Perioperative and postoperative data of all patients were analyzed. Results: There were no in-hospital mortalities following surgery, but 9 patients (56.3%) suffered major perioperative complications. Comparison of the groups that received reconstruction using the jejunum and the colon indicated similar incidences of perioperative complications, overall survival, and disease-free survival. Cox regression analysis indicated that lymph node metastasis of both cancers was independent risk factor for overall survival. Conclusion: The existence of synchronous tumors of the esophagus and stomach is not unusual, the radical surgical treatment could be carried out whenever possible. [ABSTRACT FROM AUTHOR]

Background: The pectoralis major musculocutaneous flap (PMMF) is a pedicled flap often used as a reconstruction option in head and neck surgery, especially in cases with poor wound healing. However, applying PMMF after esophageal surgery is uncommon. We report here, the case of a successfully repaired refractory anastomotic fistula (RF) after total esophagectomy, by PMMF. Case presentation: A 73-year-old man had a history of hypopharyngolaryngectomy, cervical esophagectomy, and reconstruction using a free jejunal graft for hypopharyngeal carcinosarcoma at the age of 54. He also received conservative treatment for pharyngo-jejunal anastomotic leakage (AL), then postoperative radiation therapy. This time, he was diagnosed with carcinosarcoma in the upper thoracic esophagus; cT3rN0M0, cStageII, according to the Japanese Classification of Esophageal Cancer 12th Edition. As a salvage surgery, thoracoscopic total resection of the esophageal remnant and reconstruction using gastric tube via posterior mediastinal route was performed. The distal side of the jejunal graft was cut and re-anastomosed with the top of the gastric tube. An AL was observed on the 6th postoperative day (POD), and after 2 months of conservative treatment was then diagnosed as RF. The 3/4 circumference of the anterior wall of the gastric tube was ruptured for 6 cm in length, and surgical repair using PMMF was performed on POD71. The edge of the defect was exposed and the PMMF (10 × 5 cm) fed by thoracoacromial vessels was prepared. Then, the skin of the flap and the wedge of the leakage were hand sutured via double layers with the skin of the flap facing the intestinal lumen. Although a minor AL was observed on POD19, it healed with conservative treatment. No complications, such as stenosis, reflux, re-leakage, were observed over 3 years of postoperative follow-up. Conclusions: The PMMF is a useful option for repairing intractable AL after esophagectomy, especially in cases with large defect, as well as difficulties for microvascular anastomosis due to previous operation, radiation, or wound inflammation. [ABSTRACT FROM AUTHOR]