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Oral Presentations

The Sixth National Symposium of Bariatric and Metabolic Surgery December 6th, 2014, Bucharest

Carcinomul hepatocelular dezvoltat pe ficatul gras nonalcoolic. Evaluarea riscului la pacienii cu obezitate i
sindrom metabolic
Hepatocellular Carcinoma in Nonalcoholic Liver Disease. Risk Assessment in Patients with Morbid Obesity
and Metabolic Syndrome
Roxana Maria Livadariu, V. Drug, Anca Trifan, Lidia Ionescu, R. Dnil, D. Timofte
Universitatea de Medicin i Farmacie Gr. T. Popa, Spitalul Sf. Spiridon, Iai, Romnia
Carcinomul hepatocelular devine din ce n ce mai mult asociat cu obezitatea, sindromul metabolic i ficatul gras
nonalcoolic.
Obiectivul studiului este de a sublinia principalii factori incriminai n apariia hepatocarcinomului la pacienii cu obezitate
i sindrom metabolic.
Materiale i metode: Am analizat sistematic datele din literatur legate de relaia ntre hepatocarcinom, modificrile
metabolice i sindromul de inflamaie cronic ce caracterizeaz pacientul cu obezitate. De asemenea, am studiat
retrospectiv dosarele medicale a 46 pacieni diagnosticai cu hepatocarcinom n serviciul nostru ntre 2009 i 2014;
ulterior, am analizat rapoartele anatomo-patologice ale pacienilor ce au beneficiat de chirurgia obezitii n clinica
noastr, la care s-a practicat biopsie hepatic intraoperator.
Rezultate: 95,12% dintre pacienii cu hepatocarcinom dezvoltat pe ciroz hepatic prezentau mcar unul din factorii de
risc clasici pentru carcinom hepatocelular. Steatoz hepatic a fost descris la 46,15% din aceti pacieni. Toi pacienii cu
hepatocarcinom i ciroz hepatic clasificat drept criptogenic prezentau leziuni importante de steatoz hepatic.
Pacienii la care carcinomul hepatic s-a dezvoltat n absena cirozei (4,88%) erau supraponderali sau obezi.
Anatomopatologia a artat steatoz hepatic, iar 3 dintre ei prezentau leziuni specifice de steatohepatit. Toi pacienii la
care s-a prelevat biopsie hepatic n timpul interveniei chirurgicale bariatrice au fost diagnosticai cu steatoz hepatic.
La 71,4% din cazuri s-au descris leziuni de steatohepatit, iar un pacient prezenta ciroz n evoluie.
Concluzii: Incidena hepatocarcinomului dezvoltat pe ficat gras nonalcoolic este redus, ns incidena obezitii este n
cretere. Este necesar descoperirea criteriilor pentru selecia pacienilor obezi cu risc de a dezvolta carcinom
hepatocelular.
Hepatocellular carcinoma (HHC) is becoming increasingly associated with obesity, metabolic syndrome and nonalcoholic
fatty liver disease (NAFLD). The number of HCC cases developed in absence of cirrhosis is not negligible. The aim of the
study is reviewing the main factors incriminated in the HCC occurrence in patients with obesity and metabolic syndrome.
We reviewed the literature data regarding the relationship between metabolic disorders and chronic inflammation
syndrome characterizing obese patients and HCC occurrence. We also analyzed the medical records of 46 patients treated
for HHC in our surgical unit between 2010 and 2014; then we studied the pathologic reports of the patients in whom liver
biopsy was taken during surgical intervention for morbid obesity. 95,12% of the cirrhotic patients diagnosed with HHC had
at least one of the classic risk factors for hepatocellular carcinoma; the pathological report revealed hepatic steatosis in
46,15% of these patients. For the patients with HHC classified as cryptogenic cirrhosis, the pathological report also showed
intense hepatic steatosis. All 5 non cirrhotic patients diagnosed with HHC were either overweight or obese. They had
hepatic steatosis and 3 of them had pathological marks of steatohepatitis. All patients that underwent liver biopsy with
sleeve gastrectomy were diagnosed with nonalcoholic hepatic steatosis; 5 also had pathological features of
steatohepatitis and 1 of them had evolving cirrhosis. The incidence of HCC development in patients with NAFLD is low, but
the number of obese patients is increasing constantly worldwide. Finding criteria for selection of obese patients at risk to
develop HCC is mandatory.

The First Experiences of Bariatric Surgery at the Clinic of Pediatric Surgery in Novi Sad
R. Jokic, Anti Jelena, . Draga, P. Milo, . Nenad, T. Veliko
Institute for Children and Youth Healthcare of Vojvodina, Medical Faculty Novi Sad, Clinic of Pediatric Surgery, Novi Sad,
Serbia
During the past two decades minimally invasive surgery has grown from a new method in surgical practice to the standard
surgical procedure in the treatment of many conditions and diseases. The advantages of minimally invasive surgery are
well-known and one among the most recent applications is in case of extreme obesity. Pediatric bariatric surgery is the

The Sixth National Symposium of Bariatric and Metabolic Surgery December 6th, 2014, Bucharest
surgical procedure for extremely obese children. There are several methods of bariatric surgery for adults, but resection of
the stomach ("gastric sleeve" resection) is the first choice for pediatric population all over the world.
The result is weight loss, improved control of diabetes mellitus, reduction of cardiac risk factors and consequently the
overall mortality. The most frequently cited criteria for surgery are unsuccessful conservative six-month treatment, the
value of the body mass index over 35kg/m2, and also associated pathologic conditions such as diabetes, hypertension,
"sleep apnea" etc.
In conclusion, laparoscopic gastric sleeve resection is a safe and appropriate method for obese children population. Also, it
is necessary to highlight the importance of collaboration with centeres of excellence for application of bariatric surgery.

3 ani de chirurgie bariatric la Spitalul Sf. Constantin Braov


Three Years of Bariatric Surgery in "St. Constantin" Hospital Braov
B. Moldovan, D. Pocreata, Luminia Cmpeanu, Andreea Moldovan
Spitalul Sf. Constantin", Braov, Romnia
Scop: Lucrarea i propune prezentarea experienei noastre de peste 3 ani n chirurgia bariatric.
Materiale i metode: Programul bariatric al Spitalului Sf. Constantin din Braov a nceput n anul 2011. Pn la
01.10.2014 au fost efectuate un numr de 181 de intervenii bariatrice, s-au realizat 175 de operaii de sleeve gastric
longitudinal laparoscopic, 45 dintre acestea au fost realizate prin abord unic LESS-SILS. Prin manier deschis au fost
efectuate 5 cazuri, 3 dup gastroplastie vertical deschis, 1 dup ablaie de inel pe cale clasic i un caz de eventraie
gigant cu pierderea dreptului la domiciliu, ca prim timp nainte de cura eventraiei. Menionm i un caz de gastric sleeve
laparoscopic dup Diversie Bilio-Pancreatic Scopinaro. Pe lng operaiile amintite s-au efectuat i 2 intervenii de
ablaie pe cale laparoscopic de inel gastric ca prim timp al redo surgery. BMI-ul mediu preoperator este de 45, cu limite
ntre 33 i 73,7; 5 cazuri depind grania a 200 kg. Realizm un sleeve lung, n form de J, de la 2-3 cm de pilor i
ngust, calibrat pe bujie de 30 Fr la BMI peste 40 i 34 Fr la BMI sub 40. Standardul actual pentru rezecia stomacului este
reprezentat de cartuele Purple acoperite cu Peristrip sau Tachosil aplicate alternativ pe o fa, fr sutur de nfundare.
Pentru tehnica LESS folosim de rutin Quadport plus de la Olympus.
Rezultate: S-a nregistrat o singur fistul la nivelul liniei de agrafare, rezolvat prin drenaj laparoscopic i tratament
conservator. n rest s-au nregistrat complicaii postoperatorii clasele Clavien-Dindo I i II, nenregistrndu-se decese. Din
totalul de 70 cazuri cu diabet tip II preoperator 69 sunt sevrate n prezent de terapia cu Anti Diabetice Orale sau Insulin.
Scderea ponderal medie este de 31 kg, iar durata medie de spitalizare 2,3 zile.
Materials and Methods: St. Constantin Hospitalss Bariatric Program began in 2011. Until 01.11.2014 there were
performed a total of 181 bariatric surgeries, 175 laparoscopic longitudinal gastric sleeve surgeries, 45 of these were
performed through unique LESS-SILS approach. Five (5) cases were performed through open method, 3 after vertical open
gastroplasty, 1 after ring ablation the classical method and a case of giant hernia. We also mention a case of laparoscopic
gastric sleeve after Scopinaro Biliopancreatic diversion. Apart from the previously mentioned surgeries there were also
performed 2 laparoscopic gastric ring ablation as prime time of a redo surgery. The pre-surgery mean BMI was 45, with
ranges between 33 and 73,5; 5 cases exceeding the 200 kg margin. We perform a long J shape sleeve, started 2-3 cm
above the pilorus and thin, sizeid on 30 Fr bougie for a BMI over 40 or on 34 Fr bougie for a BMI under 40. The current
standard for stomach resection is represented by Purple cartridges covered with Peristrip or Tachosil alternatively put on
one side, without clogging suturing. For the LESS technique we usually use Olympus Quadport plus.
Results: There was registered only one fistula at the stapling lines level, solved through laparoscopic drainage and
conservatory treatment. 69 from 70 type-2 diabetes patients are currently without oral anti diabetic drugs or insulin. The
average weight loss was 31 kg and the average hospitalization 2,3 days.

The Sixth National Symposium of Bariatric and Metabolic Surgery December 6th, 2014, Bucharest
Gastric Banding - Complicaii, rezultate, eficien
Gastric Banding - Complications, Results, Efficiency
S. Olariu
Universitatea de Medicin i Farmacie Victor Babe, Timioara, Romnia
Obiectiv: Studiul eficacitii gastric banding-ului prin prisma experienei personale i a datelor din literatur.
Material i metod: Am analizat rezultatele unei serii personale de 170 gastric banding-uri i le-am comparat cu datele din
literatur. Pacienii au fost obezi i superobezi (BMI mediu de 47,5). Am utilizat tehnica pars flacida cu abord
laparoscopic.
Rezultate, Discuii: Rata conversiilor a fost de 5,3%, durata medie a interveniei de 70 minute, accidente i incidente
intraoperatorii 1,3%, complicaii postoperatorii 9,3%, eecul metodei 2,6%. Cu ct indicele de mas corporeal a fost mai
mare, cu att i rezultatul postoperator a fost mai bun.
Concluzii: 1. Gastric banding-ul rmne o operaie eficient n cura obezitii morbide.
2. Dei alte tipuri de intervenii au eficacitate mai mare, datorit ratei mici a complicaiilor operaia i pstreaz
actualitatea.
3. Experiena echipei chirurgicale i codificarea tehnicii operatorii crete eficiena metodei i scade rata complicaiilor.
4. Analiza seriei prezentate, raportat la datele din literatur ne face s susinem aceast intervenie chirurgical.
Cuvinte cheie: obezitate morbid, gastric banding, studiu clinic.
Objective: The study of gastric banding effectiveness in the surgical treatment of the morbid obesity by personal
experience and literature data.
Matherials and Methods: We have analyzed the results of a personal series of 170 gastric bandings and we compared
them with the data reported in literature. Patients were obese and superobese (average body mass index 47,5). Pars
flacida technique was used by laparoscopic approach.
Results, Discussions: The conversion rate was 5.3%, average duration of surgery was 70 minutes, intraoperative accidents
and incidents 1,3%, postoperative complications 9,3%, method failures 2,6%. The weightloss was more obvious in the most
obese patients. Compared to literature data we believe the results are satisfactory.
Conclusions:
1. Gastric banding remains an effective therapeutic procedure in the surgical treatment of morbid obesity.
2. Although other processes are listed with superior results, the low complication rate and intra and postoperative risk
maintain gastric banding still up to date.
3. The teams experience and the standardization of surgical technique decreases the percentage of unwanted aspects and
increases the methods efficiency.
4. The analysed series make us support the therapeutic procedure.
Key words: morbid obesity, gastric banding, clinical study.

Chirurgia corectiv (REDO) dup procedee bariatrice la Spitalul Sf. Constantin Braov
Corrective Surgery ("Redo") after Bariatric Procedures in "Sf. Constantin " Hospital, Braov
B. Moldovan, D. Pocreata, Luminia Cmpeanu, Andreea Moldovan
Spitalul Sf. Constantin", Braov, Romnia
Scop: Lucrarea prezint experiena noastr n chirurgia corectiv dup alte procedee bariatrice.
Material i metode: n perioada aprilie 2012 - octombrie 2014, un numr de 10 pacieni cu antecedente de chirurgie
bariatric au fost reoperai n centrul nostru: 2 ablaii de inel gastric pe cale laparoscopic, 2 sleevuri la peste 6 luni de la
ablaia inelului n alte servicii (1 laparoscopic, 1 clasic dup inel clasic), 1 sleeve dup o diversie bilio-pancreatic
Scopinaro i 5 operaii combinate de ablaie de inel cu sleeve (2 clasice dup VBG clasic i 3 laparoscopice dup inel
laparoscopic). Media BMI preoperator a fost de 42,7 cu maximum de 53,6 (ablaie inel gastric+sleeve n acelai timp).
Rezultate: Rezultatele chirurgicale i bariatrice au foarte bune, 0 fistule, 0 complicaii Clavien 3-4, 1 caz de edem de tub
gastric cu reluare tardiv a pasajului transgastric, dup tratament conservator i nutriie parenteral. BMI mediu dup un
folllow-up cuprins ntre 2 i 30 de luni este de 31,6. Toate cele 3 cazuri de diabet tip II sunt sevrate de tratament.
Concluzie: Gastric sleeve este o eficient metod de redo surgery dup inel gastric i dup diversia Scopinaro. n funcie
de starea stomacului (implicit de poziia inelului), este adesea posibil efectuarea ambelor proceduri n acelai timp
chirurgical.

The Sixth National Symposium of Bariatric and Metabolic Surgery December 6th, 2014, Bucharest
Purpose: The paper presents our experience in corrective surgery after bariatric procedures.
Material and Methods: Between April 2012 and October 2014, a total of 10 patients with a history of bariatric surgery in
other centers were reoperated in our surgical department: 2 laparoscopic ablations of gastric band (only the ablation
time), 2 sleeves 6 months after the band ablation(1 by laparoscopy, one open after open band ablation), 1 sleeve after
bilio-pancreatic diversion Scopinaro failure and 5 combined operations: band ablation plus sleeve (2 open after open and
VBG and 3 laparoscopic procedures). Median preoperative BMI was 42,7 with a maximum of 53.6 (a case of combined
band ablation and gastric sleeve).
Results: Both surgical and bariatric results were very good, 0 fistula, 0 3-4 Clavien complications, one case of gastric tube
edema, treated by parenteral nutrition and conservative support till the passage recovery. The actual mean BMI after a
folllow-up between 2 and 30 months is 31,6. All the 3 cases of type II diabetes are in remission.
Conclusion: Gastric sleeve is an effective method of redo surgery after gastric band, VBG and after Scopinaro procedure.
Depending on the condition of the stomach, it is often possible to perform both procedures at the same surgical time.

The Importance of Gastric Barium Test in Bariatric Surgery


R. F. Galea, Florinela Coi Galea, E. Pop, A. Mironiuc, . Chiorescu, F. Mihileanu, O. Grad, D. V. Mircioiu
Universitatea de Medicin i Farmacie Iuliu Haieganu, Cluj-Napoca, Romnia
During 1997-2013, along 17 years, 1361 surgical procedures have been performed in the Bariatric Surgery Center form the
Second Surgical Clinic of Cluj-Napoca consisiting of 1111 silastic ring vertical gastroplasty (GVS), 162 cosmetic
interventions and 88 corrections. We had excellent results in 91.15% cases, 47 patients had an excessive weight loss and in
41 cases weight gain was noticed.
Gastric barium test was able to indicate the positive evolution of the patients, but also, when the case, the presence of
stoma stenosis, the rupture of the suture, or the enlargement of the gastric stoma.
Between 2013 and 2014 we performed 46 surgical interventions of sleeve gastrectomy and 4 of gastric by-pass, as first
operation or as conversion from GVS. The gastric barium test has given us the tips for the surgical indication as well as for
the postsurgical follow-up in order to improve the surgical technique.
In conclusion, we consider that, at the moment, sleeve gastrectomy is the best bariatric surgery procedure.

Misfire n chirurgia bariatric laparoscopic. Eroare de pilotaj sau defeciune tehnic: cine este de
nvinovit?
Misfire in Laparoscopic Stapled Bariatric Surgery. Pilot Error or Technical Failure: Whos to Blame for It?
C. Boru (1), D. I. Ulmeanu (2), V. Constantinica (1), N. Copca (1), Adina Marinciu (3), R. Poenaru (1)
(1) Spital Clinic Sfanta Maria, Bucureti, Romnia
(2) Spital Regina Maria Bneasa, Bucureti, Romnia
(3) Spital Monza, Bucureti, Romnia
Folosirea suturii mecanice laparoscopice a crescut dramatic n ultimii 20 de ani. Folosirea staplerelor n chirurgia bariatric
laparoscopic este obligatorie pentru a realiza intervenii minim-invazive, complexe i de rutin care includ ligaturi,
secionri, rezecii, anastomoze i nchiderea aponevrozei. Funcionarea defectuoas este definit ca falimentul
dispozitivului n realizarea performanelor ateptate. Problemele care pot aprea n timpul staplarii pot fi determinate de
aplicator, de cartu, de rencrcare sau de personalul din sala operatorie. Incidena acestor evenimente este foarte mic,
estimat la aprox 0,003%, dar implicaiile asupra decursului postoperator pot varia de la nesemnificative pn la efecte
catastrofice. Eroarea utilizatorului poate fi atribuit experienei personale sau aprecierii defectuoase a mrimii, lungimii
stapler-ului sau grosimii esutului. Falimentul instrumentului n formarea unei linii complete i separate de sutur
mecanic sau funcionarea defectuoas specific (funcionare parial sau imposibilitatea de a deschide stapler-ul dup
tragere) sunt cele mai comune aspecte. Raportarea acestor evenimente este obligatorie pentru a putea obine
mbuntirea att a experienei operatorului, dar i a funcionrii dispozitivului.
Use of laparoscopic mechanical suture increased dramatically in the last 20 years. Use of staplers in laparoscopic bariatric
surgery is mandatory in order to perform minimally-invasive, complex and routine procedures that include ligation,
division, resection, anastomosis and fascial closure. Malfunction is defined as failure of the device to meet its performance
expectations. Problems that one can encounter during stapling are related to stapler, cartridge, reload or operating room
personnel. The incidence of these events is very low, estimated to 0.003% but the implications on postoperative evolution

The Sixth National Symposium of Bariatric and Metabolic Surgery December 6th, 2014, Bucharest
vary from little or no consequences to catastrophic events. User error can be attributable to personal experience or
misjudge of staple size, length, tissue thickness. Device failure to form properly and suture line separation or device
specific malfunctions (staples partially firing or staples misfire and not releasing) are most common aspects. Report of
such events is mandatory in order to improve both user experience and device function as well.

Incidente i complicaii n chirurgia bariatric laparoscopic - Experiena Clinicii III Chirurgie, Spitalul Sf.
Spiridon, Iai
Incidents and Complications in Laparoscopic Bariatric Surgery - The Experience of the 3rd Surgical Unit, Sf.
Spiridon Hospital, Iai
D. Timofte (1), Mihaela Blaj (2), V. Scarlat (1), V. Vlsceanu (1), R. Soroceanu (1), Elena Mitrofan (3), Delia Pintilei (4), Nela
Damian (2), Marta Chiricu (2), Iulia Amitoaie (2)
(1) Universitatea de Medicin i Farmacie Gr. T. Popa, Spitalul Sf. Spiridon, Iai, Romnia
(2) Spitalul Sf. Spiridon, Iai, Romnia
(3) Universitatea de Medicin i Farmacie Gr. T. Popa, Iai, Romnia
(4) Spitalul Consultmed, Iai, Romnia
Obiectiv: Recunoaterea imediat a incidentelor intraoperatorii i a complicaiilor postoperatorii pentru a fi tratate ct
mai rapid.
Materiale i metode: n perioada iunie 2012 - decembrie 2014, 70 de pacieni au beneficiat de intervenii chirurgicale
bariatrice laparoscopice: 3 plicaturi (LGP), 3 extrageri de inel gastric, 64 rezecii gastrice longitudinale (LSG). La a 7-a
intervenie LSG, la aplicarea cartuului 3, jumtate din trans nu a fost staplat (interpunere dubl de mucoas),
necesitnd restaplare; pacientul 14, n ziua 2 prezint hemoperitoneu - reintervenie laparoscopic: hemostaz pe trans
gastric, lavaj, drenaj multiplu. Un alt pacient prezint ziua 1 postoperator drenaj hematic - tratament conservator. A 69-a
pacient operat (apnee n somn, HTA, LES, IRC grd I) prezint scaderea hemogramei n prima zi postoperator (Hb 7,5g/L )
fr exteriorizare de snge pe tubul de dren. Reechilibrare volemic n secia ATI, evoluie oscilant cu sngerare
intermitent; se decide reintervenie la 24 ore: hemostaz n ligamentul gastrocolic, evacuare, drenaj multiplu. Evoluie
favorabil, externare n ziua 7; revine n oc hipovolemic dup 4 zile, reintervenie laparoscopic: evacure lichid hematic
vechi lavaj, drenaj multiplu. Evoluia este lent favorabil.
Rezultate: n lotul examinat de 70 pacieni au fost prezente 3 complicaii hemoragice din care 2 au impus rentervenii
laparoscopice.
Concluzii: Pacienii obezi prezint de regul patologie asociat, o parte consecin direct a obezitii, care-i predispune la
apariia complicaiilor. Postoperator, necesarul dozelor mari de heparin fracionat favorizeaz apariia complicaiilor
hemoragice chiar i la nivelul vaselor de mici dimensiuni care eventual prin caracterul lor intermitent creeaz dificulti n
luarea deciziilor de reintervenie.
Objectives: Early recognition and immediate treatment of the intraoperative incidents and postoperative complications.
Materials and Methods: Starting from June 2012 until December 2014, 70 patients beneficiated for laparoscopic bariatric
operations: 3 laparoscopic gastric placation (LGP), 3 gastric band removal and 64 laparoscopic gastric sleeve (LGS). At the
th
rd
7 LSG, during the 3 cartridge application half of it was misstappled because of double interposition of mucosa; the 14th
patient presented hemoperitoneum at 48 hours - relaparoscopy, hemostasis, evacuation, lavage, drainage; another
th
hemoperitoneum at the 20th patient was treated conservatively; the 69 patient with LSG, at 24 hrs has a lower Hb
(7,5g/L) - volemic repletion, relatively stable for 24 hrs, intermittent bleeding - relaparoscopy, hemostasis, evacuation,
th
th
lavage, drainage; discharge in the 7 p.o. day, readmitted in the 11 p.o. day with hipovolemic shock: relaparoscopy, old
blood evacuation, lavage, drainage with slow recovery but favorable.
Results: From 70 patients, 3 had hemorrhagic complications of which 2 necessitated laparoscopic reintervention and one
misstappled incident.
Conclusions: Obese patients usually have got comorbidities direct related to obesity. The need of obtaining an
anticoagulant status with high dose of fractionated heparins to avoid thromboembolic complications predispose to
hemorrhagic events even in small vessels, which due to intermittent bleeding can create difficulties in decision making.

The Sixth National Symposium of Bariatric and Metabolic Surgery December 6th, 2014, Bucharest
Plicatura gastric laparoscopic - Experina Spitalului Judeean de Urgen Baia Mare
Laparoscopic Gastric Plication - Experience of Emergency County Hospital of Baia Mare
Mihaela Lee (1), C. Mare (2), Monica Vardai (3), A. Szasz (1), P. Radu (1), Ioana Lee (3), Lavinia Murean (1), Adriana
Stoicovici (1)
(1) Spitalul Judeean de Urgen, Baia Mare, Romnia
(2) MedHelp, Baia Mare, Romnia
(3) Fortis Diagnosis Center, Baia Mare, Romnia
Introducere: Obezitatea, cea mai frecvent boal metabolic, are repercusiuni grave asupra duratei i calitii vieii din
cauza bolilor cu care se asociaz, dar i din cauza aspectelor estetice i sociale pe care le implic. Tratamentul chirurgical,
singurul capabil s produc efecte sigure i durabile, beneficiaz de multiple opiuni. Plicatura gastric laparoscopic,
datorit multiplelor sale avantaje, este preferat de tot mai muli pacieni i profesioniti din sistemul de sntate. Scopul
studiului nostru este de a evalua rezultatele obinute n Spitalul Judeean de Urgen din Baia Mare cu aceast tehnic
chirurgical, complicaiile postoperatorii i costurile asociate.
Materiale i metode: n cursul anului 2014, plicatura gastric laparoscopic a fost efectuat la 12 pacieni obezi, cu indice
de mas corporal ntre 35,7 i 59,8 i vrsta ntre 25 i 60 de ani.
Rezultate: Nu s-a nregistrat nicio complicaie postoperatorie, iar pierderea medie n greutate a fost de 14,7 kg n prima
lun de la operaie.
Concluzii: Plicatura gastric laparoscopic este urmat de rezultate bune, are cost redus i cele mai mici rate de
complicaii i mortalitate postoperatorie din chirurgia bariatric, fiind o operaie fezabil pentru majoritatea spitalelor din
Romnia.
Background: Obesity, the most common metabolic illness, has serious repercussions on life span and life quality because of
the associated diseases, but also due to its involvement in the aesthetic and social aspects. Being the only one able to
produce reliable and long-lasting effects, the surgical treatment has multiple options. The laparoscopic gastric plication is
preferred by more and more patients and professionals of the health system due to its many advantages. The aim of our
study is to assess the results obtained in the Emergency County Hospital of Baia Mare with this surgical technique, the
postoperative complications and the associated costs.
Materials and Methods: In 2014, the laparoscopic gastric plication was performed on 12 obese patients with body mass
index between 35,7 and 59,8 and age between 25 and 60 years.
Results: There was no postoperative complication, and the average weight loss was 14.7 kg in the first month after the
operation.
Conclusions: The Laparoscopic gastric plication is followed by good results, has reduced costs and the lowest rates of
complications and postoperative mortality in bariatric surgery, being a feasible operation for most hospitals in Romania.

Scdere ponderal semnificativ fr caren de vitamina D i vitamina B12 la 12 luni dup gastrectomie
longitudinal
Significant Weight Loss Without Vitamin D and Vitamin B12 Deficiency at 12 Months after Gastric Sleeve
S. S. Pdureanu, Lidia Iuliana Arhire, Laura Mihalache, R. S. Gavril, A. C. Oprescu, Mariana Graur, Alina Ursache
Universitatea de Medicin i Farmacie Gr. T. Popa, Iai, Romnia
Obiectiv: Urmrirea parametrilor antropometrici i a unor parametri nutriionali importani (vitamina D i B12) n postoperator la pacienii cu gastrectomie longitudinal.
Materiale i metode: Pacienii cu obezitate, cu indicaie de chirurgie metabolic, trec printr-un bilan complex
preoperator i sunt urmrii din punct de vedere clinic i nutriional, post-operator, la 1, 3, 6 i 12 luni. Din evalurile
efectuate, am analizat greutatea (G), indicele de mas corporal (IMC), vitamina D i vitamina B12 pre- i post-operator.
Rezultate: Am analizat 32 de pacieni (23 femei), vrst medie 40.912 ani. Preoperator, G=1224.7 kg, iar post-operator,
G a sczut semnificativ statistic, la 108.721.2 kg la 1 lun (p<0.001), 97.821.4 la 3 luni (p<0.001), 93.617.9 kg la 6 luni
(p<0.001) i la 9514.1 kg la 12 luni (p=0.003). IMC preoperator a fost 436.6 kg/m2, iar post-operator s-a constatat
aceeai scdere semnificativ statistic: 38.47.6 kg/m2 la 1 lun (p<0.001), 34.58.2 kg/m2 la 3 luni (p<0.001), 35.38.5
kg/m2 la 6 luni (p<0.001) i 32.67.4 kg/m2 la 12 luni (p=0.006). Vitamina D preoperator a fost de 17.89.2 ng/dl, la 6 luni
post-operator a crescut la 22.913.2 ng/dl, iar la 12 luni post-operator a fost de 26.15.1 ng/dl. Vitamina B 12
preoperator a fost de 310101 pmol/l, la 6 luni post-operator: 29197 pmol/l, iar la 12 luni post-operator a fost

The Sixth National Symposium of Bariatric and Metabolic Surgery December 6th, 2014, Bucharest
539.4338 pmol/l (toi pacienii au avut indicaie de suplimentare cu vitaminele D i B12). Concluzii: Pacienii urmrii au
avut o scdere n greutate adecvat, iar 12 luni post-operator valorile vitaminei D i B12 au fost mai mari dect
preoperator.
Objective: Anthropometric and nutritional assessment (vitamin D and B12) before and after gastric sleeve.
Matherials and Methods: Obese patients, with indication for metabolic surgery, undergo a complex preoperative
assessment, and are followed after surgery at 1, 3, 6, and 12 months clinically and nutritionally. Presently, we evaluated
weight (W), body mass index (BMI), vitamin D and B12 before and after surgery.
Results: We analysed 32 patients (23 women), average age 40.912 years. Preoperative, W=1224.7 kg, and after surgery,
W decreased statistically significant, to 108.721.2 kg at 1 month (p<0.001), 97.821.4 at 3 months (p<0.001), 93.617.9
kg at 6 months (p<0.001) and to 9514.1 kg at 12 months (p=0.003). BMI preoperative was 436.6 kg/m2, whereas postoperative decreased statistically significant: 38.47.6 kg/m2 at 1 month (p<0.001), 34.58.2 kg/m2 at 3 months (p<0.001),
35.38.5 kg/m2 at 6 months (p<0.001) and 32.67.4 kg/m2 at 12 months (p=0.006). Vitamin D preoperative was 17.89.2
ng/dl, at 6 months post-operative increased to 22.913.2 ng/dl, and to 26.15.1 ng/dl at 12 months after surgery. Vitamin
B 12 preoperative was 310101 pmol/l, at 6 months post-operative: 29197 pmol/l, and at 12 montths post-operative was
539.4338 pmol/l (all patients were recommended to take suppliments with vitamin D and B12).
Conclusions: The patients we followed had an adequate weight loss and improved the level af vitamin D and vitamin B12
at 12 months after surgery.

Bile Acids, Type 2 Diabetes and Obesity - Is Metabolic Surgery the Key?
Florinela Coi Galea (1), R. F. Galea (1), A. Mironiuc (1), C. Copescu (2)
(1) Universitatea de Medicin i Farmacie Iuliu Haieganu, Cluj-Napoca, Romnia
(2) Spitalul Ponderas, Bucureti, Romnia
Bile acids are recognized as key regulators of systemic metabolism modulating glucose homeostasis. In humans, the levels
of bile acids correlate with insulin sensitivity. Their metabolism is altered in type 2 diabetes and the levels seem to be
increased after metabolic surgery leading to improved insulin sensitivity and restoration of glycaemic control. Surgical
procedures that involve rerouting of the food induce an increase of bile acids, but new data have showed that substantial
changes in circulating total bile acids are known to occur after sleeve gastrectomy as well. It seems that total serum bile
acids are inversely correlated with 2-hour postprandial glucose levels and positively correlated with glucagon-like peptide1 (GLP-1) levels. The mechanism by which bile acids increase in the enterohepatic circulation is not fully understood, but it
might be a result of an increased uptake in the intestines or an increased synthesis in the liver.

Teoria incretin n chirurgia diabetului


The Incretin Theory in the Surgery of Diabetes
S. Blan, S. Revencu, G. Conu, O. Conu, D. Revencu
Universitatea de Stat de Medicin i Farmacie Nicolae Testemianu, Chiinu, Republica Moldova
Obezitatea i diabetul zaharat tip 2 pot deveni cele mai mari probleme ale sntii publice n viitoarele decenii.
Modificarea stilului de via, tratamentul medicamentos rmn ineficiente.
Chirurgia bariatric n tratamentul obezitii morbide comport o rat nalt de rezoluie complet i a diabetului zaharat
tip 2. Mecanismul rezoluiei diabetului zaharat tip 2 dup interveniile bariatrice rmne neelucidat. CD4 i CD8 joac un
rol distinct i patogenic nalt n instalarea diabetului zaharat tip 1.
Obiectivul: Evaluarea eficacitii by-pass-ului gastric (BG) n tratamentul diabetului zaharat tip 2 (DZ 2) la pacienii cu
obezitate, precum i a mecanismelor ce stau la baza controlului glicemic.
Materiale i metode: Studiul prospectiv include 27 pacieni cu DZ 2 supui BG pe perioada 2009 - 2014. Durata diabetului
a fost de 30,5 ani, IMC preoperator fiind de 42,41,4 kg/m. Valorile medii ale glicemiei bazale i hemoglobinei glicolizate
au constituit 9,50,7 mmol/l i respectiv 7,20,2 %. n toate cazurile s-a prelevat segment de intestin subire pentru
examenul histochimic.
Rezultate: Sunt relatate rezultatele postoperatorii pe o perioad de 16,93,4 luni. IMC a constituit 29,40,9 kg/m,
glicemia bazal i hemoglobina glicolizat au constituit 5,50,2 mmol/l i respectiv 5,50,1 %. Examenul histochimic a
evideniat un infiltrat inflamator cronic constituit din limfocite T, preponderent CD4 i CD8.

The Sixth National Symposium of Bariatric and Metabolic Surgery December 6th, 2014, Bucharest
Concluzii: Diabetul zaharat tip 2 pare a fi iniiat de acelai lan patogenetic ca i diabetul tip 1. Studiul preliminar relev
eficacitatea by-pass-ului gastric, fiind o opiune promitoare n tratamentul diabetului zaharat tip 2.
Obesity and type 2 are likely to be the two greatest public health problems of the coming decades. Lifestyle changes and
drug therapy remain ineffective. Bariatric surgery, an effective treatment for morbid obesity, commonly leads to near
complete resolution of type 2 diabetes (T2DM). The underlying mechanisms, however, remain unclear. The CD4 and CD8
cells play distinct and highly pathogenic roles mediating type 1 diabetes.
Objective: To assess the potential and mechanisms of the gastric bypass (RYGBP) in affecting glycemic control in obesity
subjects with T2DM.
Materials and Methods: This prospective clinical trial includes 27 patients with T2DM who underwent RYGBP from 2009
through 2014. Duration of diabetes was 30,5 years, and preoperative BMI of 42,41,4 kg/m. The blood glucose and
glycosylated haemoglobin were 9,50,7 mmol/l and 7,20,2 %, respectively. A part of the small bowel was taken for the
histochemical examination.
Results: We report the preliminary postoperative follow-up data of 16,93,4 months. BMI decreased to 29,40,9 kg/m,
blood glucose and glycosylated haemoglobin were 5,50,2 mmol/l and 5,50,1 %, respectively. The histochemical exam
emphasized the presence of a chronic inflammatory infiltrate in the lamina propria mostly constituted of CD4 and CD8 T
lymphocites.
Conclusions: Both type 2 diabetes and type 1 diabetes can have a common pathogenic mechanism. Our preliminary
observations demonstrated the efficacy of Roux-en-Y gastric bypass as a promising option in T2DM.

Gastric sleeve: dificulti i provocri n experiena noastr


Sleeve-Gastrectomy: Pitfalls and Challenges in Our Experience
R. C. Popescu, Cristina Dan, Alina Vinca, M. D. Hritcu
Spitalul Clinic Judeean de Urgen Sf. Apostol Andrei, Constana, Romnia
Obiective: Chirurgia bariatric este o provocare pentru fiecare chirurg specializat n tehnicile de chirurgie laparoscopic
avansat prin particularitile locale i generale ale fiecrui pacient. Asocierea altor afeciuni ce necesit tratament
chirurgical poate ridica probleme n rezolvarea concomitent a acestora.
Materiale i metode: Prezentm experiena personal pe parcursul ultimilor 2 ani ntr-o singur echip chirurgical din
Constana, constnd din 67 de cazuri de obezitate morbid n care s-a practicat gastrectomie longitudinal laparoscopic.
Pacienii au prezentat un IMC cuprins ntre 38 i 57 kg/m2 i vrsta ntre 17 i 62 de ani. Dificultile intraoperatorii au
provenit din asocierea cu alte patologii: litiaza vezicular (8 cazuri), eventraii postoperatorii (5 cazuri), hernie ombilical
(3 cazuri). De asemenea, 11 pacieni au prezentat un abdomen cicatricial avnd antecedente operatorii n etajul
abdominal superior ce au generat probleme de abord i visceroliz.
Rezultate: Evoluia postoperatorie a fost lipsit de complicaii postoperatorii imediate, fiind similar n termeni de ngrijiri
postoperatorii i recuperare cu o gastrectomie longitudinal simpl, cu externare ntre 2-5 zile postoperator.
Concluzii: ntr-o tehnic desvrit, asocierea gastric-sleeve cu alte intervenii nu crete morbiditatea postoperatorie, ci
doar perioada de spitalizare.
Objectives: Bariatric surgery is a challenge for any surgeon specialized in advanced laparoscopic techniques due to local
and general particularities of every patient. The associated surgical comorbidities can generate difficulties in simultaneous
surgical approach.
Materials and Methods: We present the personal experience accumulated in the last 2 years in a single surgical team in
Constana, consisting of 67 cases of morbid obese patients where we performed laparoscopic sleeve-gastrectomy. The
patients had a BMI between 38 and 57 kg/m2 and they were between 17 and 62 years old. Intraoperative difficulties came
from the added comorbidities: gallstones (8 cases), incisional hernia (5 patients) and umbilical hernia (3 cases). Also, 11
patients had previous upper abdominal surgery that generated problems in the surgical approach and treatment of
adhesions.
Results: Postoperative evolution was free of immediate complications, being similar in terms of postoperative care and
rehabilitation with a standard sleeve-gastrectomy, with discharge from hospital between 2 and 5 days.
Conclusions: With an impeccable technique, the association of other surgical interventions does not increase postoperative
morbidity, only the duration of hospital stay.

The Sixth National Symposium of Bariatric and Metabolic Surgery December 6th, 2014, Bucharest
Plicatura gastric - O promisiune neonorat
Gastric Plication - an Unfulfilled Promise
I. C. Puia (1), P. G. Cristea (1), Aida Puia (2)
(1) Institutul Regional de Gastroenterologie i Hepatologie Octavian Fodor, Cluj-Napoca, Romnia
(2) Cabinet Medicin de Familie, Cluj-Napoca, Romnia
Obiectiv: Studiul prezint rezultatele obinute la 15 pacieni crora li s-a practicat operaia de plicatur gastric.
Materiale i metode: Pacienii au fost operai pentru obezitate ntre 2010 i 2011. De obicei abordul a fost laparoscopic i
doar ntr-un singur caz plicatura a fost o operaie secundar asociat. Toi s-au ncadrat n cerinele chirurgiei bariatrice,
cu indice de mas corporal (IMC) peste 40 sau peste 35, complicat cu comorbiditi (hipertensiune arterial,
dislipidemie, apnee n somn). Diabetul a prezentat un criteriu aparte, IMC minim fiind de 31. Parametrii urmrii au fost
vrsta, sexul, variaia IMC i a greutii, evoluia comorbiditilor legate de obezitate.
Rezultate: Intervalul mediu de urmrire a fost de 30 luni. Dup o slbire iniial extrem de variabil (minim 7 kg - maxim
35) toi pacienii au nregistrat o cretere n greutate de minim 5 kg i maxim 40 kg, depind n 5 situaii greutatea
preoperatorie. La aceste aspecte negative s-au adugat vrsturile postoperatorii frecvente i persistente ca durat la
66% din pacieni, care au necesitat eliberarea celui de-al doilea strat la dou paciente. La una dintre ele a aprut o fistul
gastric imediat dup reintervenie. Tomografia computerizat efectuat cu stomacul plin cu ap la una din pacientele
care nregistrase un ctig important n greutate a evideniat o dilataie cu aspect sacciform segmentar.
Concluzii: Pe baza rezultatelor dezamgitoare la distan, a disconfortului postoperator, a complicaiilor i a gradului
crescut de dificultate tehnic, nu credem c plicatura gastric are calitile necesare pentru a intra n arsenalul curent al
tehnicilor de chirurgie bariatric modern.
Objective: This study presents the results for 15 patients with gastric plication.
Material and Methods: 15 patients were operated for obesity in our clinic between 2010 and 2011. Usually the approach
was laparoscopic and in one case only the gastric plication was a secondary associated operation. All were within the
requirements of bariatric surgery, with a body mass index (BMI) over 40, or with one over 35 complicated with
comorbidities (hypertension, dyslipidemia, sleep apnea). Diabetes presented a special criterion, the minimum BMI of 31.
The monitored parameters were age, sex, BMI and weight variation, evolution of comorbidities related to obesity.
Results: The mean follow-up was 30 months. After an initial extremely variable weight loss (minimum 7 kg - maximum 35)
all patients experienced a weight gain of at least 5 kg and 40 kg maximum, exceeding the initial preoperative weight in 5
situations. To these negative aspects we add frequent and persistent postoperative vomiting in 66% patients which
necessitated the release of the second layer in two patients. For one of them a gastric fistula developed immediately after
reoperation. CT scan performed on another patient with weight gain, with a stomach filled with water, showed a
segmental sacciform dilatation.
Conclusions: Based on the disappointing long term results, postoperative discomfort, complications and the increased
degree of technical difficulty we do not believe that gastric plication has the necessary qualities to enter the current
arsenal of bariatric surgical techniques.

Gastroplicatura laparoscopic: indicaii, rezultate, perspective. Experiena dup 30 de cazuri operate


Laparoscopic Greater Curvature Plication: Indications, Results, Perpectives. Our Experience after 30 cases
O. C. Borz (1), T. Bara (1), T. Bara Jr. (1), A. Suciu (1), M. Denes (1), O. Jimborean (1), A. Torok (1), T. Kantor (1), B. Borz (2)
(1) Spital Clinic Judeean de Urgen, Trgu-Mure, Romnia
(2) Universitatea de Medicin i Farmacie, Trgu-Mure, Romnia
Gastroplicatura laparoscopic este o procedur bariatric recent, folosit n tratamentul obezitii morbide. Prezentm
indicaiile i rezultatele obinute dup 30 de cazuri operate. ntre 2013 i 2014 am operat 30 de pacieni cu obezitate
morbid, avnd BMI mediu de 42,65. Am efectuat gastroplicatur laparoscopic la toi bolnavii. Postoperator, procentul
excesului de greutate pierdut a fost de 51% la 6 luni i 65% la 12 luni. Complicaii care au necesitat reintervenie am avut
la 2 cazuri (o perforaie gastric i o stenoz antral), acestea aprnd la primii 6 bolnavi (curba de nvare). n restul
cazurilor am nregistrat doar complicaii minore: greuri, vrsturi. Considerm gastroplicatura laparoscopic o metod
promitoare n tratamentul obezitii morbide, dar la care nu avem rezultate la distan, necesitnd studii ulterioare.

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The Sixth National Symposium of Bariatric and Metabolic Surgery December 6th, 2014, Bucharest
Laparoscopic Greater Curvature Plication is an emerging bariatric procedure in the treatment of morbid obesity. Between
2013 and 2014 we operated 30 patients with a mean BMI of 42,65. We present the indications and the results after this
series. The percentage of excess weight loss was 51% at 6 months and 65% at 12 months. Complications that needed
reoperations were encountered only in the first 6 cases (one gastric perforation and one antral stenosis) probably due to
the learning curve. In the rest of the cases appeared minor complications (nausea and vomiting). We consider
Laparoscopic Greater Curvature Plication a promising procedure, but we need long term results and future studies.

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The Sixth National Symposium of Bariatric and Metabolic Surgery December 6th, 2014, Bucharest

E-poster
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The Sixth National Symposium of Bariatric and Metabolic Surgery December 6th, 2014, Bucharest
Gastric Sleeve Less, experiena spitalului Sf. Constantin Braov
The "Sf. Constantin" Hospitals Experience with Gastric Sleeve Less
B. Moldovan, D. Pocreata, Luminia Cmpeanu, Andreea Moldovan
Spitalul Sf. Constantin", Braov, Romnia
Scop: Prezentarea experienei noastre cu privire la chirurgia bariatric prin abord unic LESS.
Materiale i metode: Programul bariatric LESS al Spitalului Sf. Constantin din Braov a nceput n Iunie 2012. Din totalul
celor 175 de gastric sleevuri n spitalul nostru, 45 (26%) au fost realizate prin abord unic LESS-SILS. Propunem de rutin
aceast tehnic pacienilor cu BMI ntre 35 i 40, ns am aplicat-o cu succes pn la un BMI de 50,2 cu o conformaie
favorabil. Folosim de rutin Quadport plus de la Olympus, amplasat ombilical la 40 de cazuri sau supraombilical n 5
cazuri de pacieni longilini.Folosim instrumentar de 5 mm(camer, pense Storz curbe, Ligasure) pentru a reduce
conflictele la nivelul portului de lucru. Sonda de calibrare este de 34 de Fr pentru pacienii cu BMI sub 40 i de 30 de Fr
pentru cei de peste 40. Standardul actual pentru rezecia stomacului este reprezentat de cartuele Purple acoperite cu
Peristrip sau Tachosil aplicate alternativ pe o fa, fr sutur de nfundare.
Rezultate: Nu s-au nregistrat complicaii clasele 3-4 Clavien, 1 hematom perigastric resorbit spontan, 2 eventraii
postoperatorii dintre care 1 la o pacient aflat sub tratament inhibitor al cicatrizrii pentru o maladie autoimun.
Scderea ponderal medie este de 28 kg, iar durata medie de spitalizare 2,3 zile. Gastric sleeve LESS este o procedur
sigur, reproductibil i cu rezultate similare din punct de vedere al eficienei bariatrice cu varianta standard, avnd ca
principal beneficiu aspectul estetic, ceea ce o face s fie preferat de pacienii tineri.
Purpose: To present our experience on single site approach bariatric surgery(LESS Sleeve Gastrectomy).
Method: The "St. Constantin" Hospitals LESS bariatric program started in June 2012. Of the 175 gastric sleeves performed
in our hospital, 45 (26%) were performed by single site approach LESS-SILS. We propose this technique routinely in patients
with BMI between 35 and 40, but it was successfully applied up to a BMI of 50.2 with a favorable gynoid conformation.
We routinely use the Olympuss Quadport plus port located within the umbilical scare in 40 cases or 2-3 supraombilicaly in
5 cases of tall patients. We use 5 mm instruments (Scope, curved Storz forceps, Ligasure) to reduce "conflicts" inside the
working port. The calibration probe is 34 Fr for patients with BMI below 40 and 30 Fr for those over 40. Our current
standard for resection of the stomach is the use of Purple cartridges coated with TachoSil or Peristrip applied on one side
alternately without overseewing.
Results: No complications Clavien grades 3-4 were recorded, one perigastric hematoma resorbed spontaneously, 2
postoperative incisional hernias of which 1 in a patient under treatment with wound healing inhibitor for autoimmune
disease. Average weight loss was 28 kg and average length of stay 2.3 zile.
Conclusion. Gastric sleeve LESS is a safe procedure, reproducible and with similar results in terms of bariatric efficiency as
standard sleeve procedure, but with the main benefit in aesthetic results, which makes it preferred by younger patients.

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The Sixth National Symposium of Bariatric and Metabolic Surgery December 6th, 2014, Bucharest

Video Presentation
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The Sixth National Symposium of Bariatric and Metabolic Surgery December 6th, 2014, Bucharest
How You Can Remove The Minimizer Band?
A. Neimark, N. Aleksandr
Saint-Petersburg Pavlov State Medical University, Saint-Petersburg, Russia
Gastric banding is one of the most popular bariatric surgical operation today. However, the last few years have seen a
sharp decline in the percentage of gastric banding, from 42% in 2008 to 9% in 2013. This has to do with the accumulated
negative experience, and with the emergence of longitudinal gastrectomy, which is increasingly gaining popularity the
world over, having reached, in 2013, the 38% mark in the overall bariatric surgery spectrum (Angrisani).
One of the most serious postoperative complications is gastric band erosion (migration). According to the literature, the
incidence of this complication is ranging from 0.23% to 32.6% (O'Brien). As a rule, band erosion is clinically shown in the
port site suppuration and in the absence of obstruction to food ingestion.
Today's world market offers a large variety of gastric band models, of which the most frequently used are Lap-band and
SAGB. Nevertheless, every surgeon may be faced with a case of migrating band made by some other manufacturer.
We are presenting a related clinical case here. A female patient, 42 years old, underwent gastric banding 3 years ago.
Resulting weight loss: 22 kg. The patient sought assistance at the clinic complaining of the festering port site infection.
Endoscopic examination thereof revealed a partial band migration into the gastric lumen. The band model identified was
Minimizer. Taking into account its design features (special loops for fixing, hard silicone, with rough projections in the lock
area), the option of endoscopic removal seemed doubtful. Analysis of the relevant literature resulted in finding only one
article describing this type of gastric band removal. Attention was drawn to complications accompanying endoscopic
removal, to the impossibility of removing the band from the channel, to the jamming of the band in the gastric lumen, with
rupture of the esophagus at band traction.
The undertaken endoscopic procedure involved the forming of a nitinol wire loop around the band, followed by the cutting
of the band by means of a lithotripter. Traction into the gastric lumen was unsuccessful. A laparoscopy was carried out.
The band lock was isolated from the scar adhesions, and thereupon extracted from its bed. The perforation hole was
stitched.
Conclusion: In the diagnostics of migrated gastric bands, it is important to determine the band model.
In removing the band it would always be desirable to cut the band endoscopically, as this will reduce the scope of band
isolation at laparoscopy and thereby lessen the operation trauma.
Gastric band cutting does not require the use of special tools, which reduces the cost of endoscopic removal procedure.

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