No abstract

Both r-SG and r-RYGB are safe procedures with similar outcomes in terms of %EWL. As a result of the long-term potential nutritional complication of r-RYGB, r-SG may be a better option in this group of patients. Longer follow-up is needed.

In this single-surgeon, single-center experience, sleeve gastrectomy was a safe and effective bariatric procedure with a low complication rate. Staple line reinforcement by oversewing was associated with low bleeding complications and no leakage. The majority of patients with postoperative bleeding could be managed conservatively. In our experience, reduced port technique and revisional sleeve gastrectomy had similar complication rates compared to multiport and primary sleeve gastrectomy.

Orbital metastases from breast cancer (BC) are rare, but often debilitating. BC accounts for nearly half of metastases to the orbit. Orbital metastases may be discovered years after the initial diagnosis of BC, and are rare at initial presentation. A search of the institutional data base at an academic cancer center identified BC patients who developed or presented with orbital metastases from 2000 to 2013. Baseline characteristics, treatment modalities, survival and treatment responses were collected from the electronic medical record. There were 20 patients identified with orbital metastases (0.7% of all BC cases). The median age at diagnosis of BC was 49 years; 80% had estrogen positive disease. The interval between the initial diagnosis of BC and the presentation of orbital metastases was 8.5 years (0-19 years). Orbital disease was the initial presentation of BC in two cases. Three patients developed bilateral orbital metastases and seven had accompanying brain metastases. The most common presentation was decreased vision (55%), followed by diplopia (25%). The median survival after orbital metastases was 24 months. Thirteen patients (65%) received local radiation therapy. Of those radiated, 90% reported improvement of orbital symptoms. Other treatments included intraocular bevacizumab, surgery, and systemic therapy. Orbital metastases tend to occur in estrogen receptor positive disease and are often found years after BC onset. Orbital metastases may be associated with the development of brain metastases. Radiotherapy is the preferred local therapy and had high symptom control in this cohort. Oncologists should be aware of the signs of orbital metastases and the treatment options.

Postoperative bleeding was defined as a drop of hemoglobin of more than 2 g associated with pallor, tachycardia, and abdominal pain and distension. Intra-abdominal fluid collections were sought by abdominal CT scan.All patients who had bleeding (as defined before) required blood transfusion; however, major bleeding that required reoperation was seen in three patients who presented not only with drops of hemoglobin and tachycardia but they were in a state of shock, and they required urgent resuscitation and reoperation laparoscopically. All patients presented with postoperative bleeding and none was intraoperative [1].Our rate of postoperative bleeding was within the range of what has been reported in the literature, and we did not encounter intraoperative bleeding.We avoid using clips or electrocoagulation since we think they are unsafe and may contribute to increase risk of postoperative leak. Instead, we suture the staple line, which is cheap too and we inspect it carefully. If we notice any further bleeding, we reinforce the site of bleeding with figure of eight stitch rather than using clips or electrocoagulation. With this technique that we have adopted lately, we have noticed further reduction in our postoperative bleeding rate.We had no leaks in our series and regional ischemia, and leak following oversewing was shown in animal studies and was not supported by clinical studies.