This trial was registered retrospectively on November 14, 2014, at the German Clinical Trials Register as DRKS00007143.

IntroductionDuodenal ulcer lesions can represent a surgical challenge, especially if the duodenal wall is chronically inflamed, the defect exceeds a diameter of 3 cm and the ulceration is located in the second part of the duodenum.Patient and methodWe present the case of a 70-year-old male, who suffered from a 3 x 4 cm duodenal defect caused by duodenal pressure necrosis due to a 12.5 x 5.5 x 5 cm gallstone. Additionally, this stone caused intestinal obstruction (Bouveret’s syndrome) and bleeding with signs of shock. Besides the gallstone extraction, the common bile duct was drained by a T-tube and the duodenal defect closure was performed by a gastroduodeno-plasty and Bilroth II gastroenterostomy. The postoperative phase was uneventful. The reconstructed duodenum was endoscopically accessible and showed no pathological findings on follow-up.ConclusionThe reconstruction of a large defect (> 3 cm) of the second part of the duodenum is safely feasible by a gastroduodeno-plasty. The critical gastroduodenal anastomosis can be protected by duodenal decompression, achieved by placing a T-tube in the common bile duct.

Sleeve gastrectomy seems to be an effective surgical option for the treatment of morbid obesity with a low complication rate. During the first year after the operation weight loss was excellent and weight-related comorbidities such as diabetes and hypertension improved significantly. The transvaginal hybrid NOTES technique can be performed but there is still need for additional trocars through the abdominal wall. Long-term results with respect to a durable weight loss and obesity-associated comorbidities are still lacking. The results of sleeve gastrectomy are at present comparable to those of a RNY bypass.