No abstract

Gastric leak is the most dangerous postoperative complication of laparoscopic sleeve gastrectomy. Traditional surgical treatment options and endoscopic stent placement are not always successful. Negative Pressure Wound Therapy (NPWT) has shown itself like a new successful and feasible treatment option for leaks of different etiology after gastro-esophageal surgery.The initial body mass index (BMI) of the patient was 46 and co-morbidity was represented: arterial hypertension, type 2 diabetes and dyslipidemia. NPWT was initiated in 14 days after laparoscopic sleeve gastrectomy. The abdominal part of the system were changed 3 times for14 days. The patient was discharged from the hospital in 14 days after the secondary sutures to the wound. No relevant complications related to the procedure were observed during the course of the vacuum therapy. It combines defect closure, effective drainage and allows doing a periodic inspection of the wound cavity. NPWT is a successful, safety and effective treatment option for the leaks after laparoscopic sleeve gastrectomy

Early complications after Bilroth-II gastric resection for peptic ulcer disease are duodenal stump failure, anastomosis, postoperative pancreatitis, anastomosis stitch failure, etc. First of all duodenostasis underlies these complications, and it appears as a result of duodenum atony and accumulation of bile, pancreatic juice and gastrointestinal contents in it. The resultant increase in hydrostatic pressure in the duodenal cavity can lead to residual limb failure. In addition, increased hydrostatic pressure contributes to inflammatory phenomena in the area of the junction, supports intestinal paresis and, preventing further secretion of pancreatic juice, leads to pancreatitis. Lack of enteral nutrition in the postoperative period disturbs metabolism and reduces plastic capabilities of the body. Stagnation of intestinal contents also has a toxic effect.

Barrett’s esophagus is considered as a predictor of esophageal adenocarcinoma with multistage neoplastic progression at present time. The research assessed an expression of microRNA-21 in 25 patients with different degree of metaplasia and dysplasia of mucous coat of esophagus. The level of expression of microRNA depended on the presence and degree of expression of neoplastic changes of mucous coat of esophagus. The expression rising of microRNA was noted in patients with columnar-celled metaplasia and intraepithelial neoplasia and in case of esophageal adenocarcinoma. The treatment strategy could be determined by the method of estimation of the level of microRNA expression in biopsy material from mucous coat of esophagus in patients with gastroesophageal reflux disease and using other criteria.

The article presents clinical case surgical treatment of obesity in the patient with Prader-Willy-Labhart syndrome (PWS). The patient had characteristic phenotypic features of the disease: low growth, narrow temporal part of the skull, dolichocephaly, acromicria. There was a delay in psychomotor development, hypogonadism. Excess body weight was noted from three years old with a gradual progression of obesity. Now patient is 23 and her weight is 159 kg with an increase of 150 cm (BMI 70.7 kg/m2). The co-morbidities were represented by arterial hypertension, type 2 diabetes and bronchial asthma. The indication for surgical treatment was the morbid (III degree) obesity by the Prader-Willy-Labhart syndrome, complicated by the development of diseases associated with overweight and non-medicated therapy. After a long (three-week) preoperative preparation aimed at correcting the manifestations of bronchial asthma and obesity-related diseases, laparoscopic sleeve gastrectomy was performed. The choice of the procedure of operation was determined by its pathogenetic reasonability (resection the most part of the stomach, which is producing ghrelin), and severe comorbid background (which is limiting the time of surgery) and severe hyperphagia (which is requiring a procedure with a predominantly restrictive mechanism of action). After operation period flowed without complications. The patient noted decrease of the appetite and the relief keeping nutrition's regime. A year after laparoscopic sleeve gastrectomy the patient achieved reduction of 59 kg body mass and remission of co-morbidities. A positive effect in metabolic profile allows us to consider laparoscopic sleeve gastrectomy as an effective method for treating patients with Prader-Willy-Labhart syndrome.