PURPOSE To present an option technique during the accomplishment of a "Roux-en-Y" hepaticojejunostomy that, allows future transgastric endoscopic access to the biloenteric anastomosis. METHODS The side-to-side "Roux-en-Y" hepaticojejunostomy is carried through transmesocolic, retrogastric short tunnel. A distal jejunal loop of approximately 10,0 to 15,0 cm must be kept far from the anastomosi...

The metabolic effects of Roux-en-Y gastric bypass (RYGB) are caused by postsurgical changes in gastrointestinal anatomy affecting gut function. Glutamine is a critical gut nutrient implicated in regulating glucose metabolism as a substrate for intestinal gluconeogenesis. The present study examines the effects of obesity and RYGB on intestinal glutamine transport and metabolism. First, lean and ...

Despite the many benefits of bariatric surgery in patients with morbid obesity, concerns have been raised over its association with severe hyperinsulinemic hypoglycemia and nesidioblastosis following Roux-en-Y gastric bypass surgery. Cases have been described with severe post-prandial hypoglycemia with neurological symptoms following surgery. Some of these cases are recalcitrant to medical trea...

INTRODUCTION Duodenal obstruction in case of chronic pancreatitis is a very rare occurrence and usually presents with gastric outlet obstruction. These cases sometimes require surgical intervention when conservative treatment fails. Gastrojejunostomy and vagotomy has conventionally been performed for management of these cases. PRESENTATION OF CASE In this report, we present two cases of isola...

INTRODUCTION In patients with Billroth II (B II) or Roux-en-Y anatomy, endoscopic retrograde cholangiopancreatography (ERCP) is demanding. Here, we describe a novel simulator with simulated fluoroscopy for cannulation and sphincterotomy training in such situations. METHODS A custom-made simulation system was built based upon a common chassis of a series of previously described ERCP simulators...

Background: Prevalence of obesity in the world, in both developed and developing countries, is growing rapidly. Bariatric surgery is now accepted as the treatment for morbid obesity. Objective: This study compares laparoscopic sleeve gastrectomy's effectiveness (LSG) with the most common bariatric surgery, laparoscopic Roux-en-Y (LRYGB) gastric bypass.   Methods: A systematic review ...

A 41-year-old man presented with a 24hour history of melena and exacerbated epigastric pain 6 years after undergoing a laparoscopic Roux-en-Y gastric bypass for morbid obesity. He had been experiencing recurrent abdominal pain and episodes of melena in the preceding months. His past medical history also included protein C deficiency and a pulmonary embolism treatedwith anticoagulant therapy, wh...

BACKGROUND Anastomotic stricture is a complex and substantial complication following Roux-en-Y hepaticojejunostomy. Initially, endoscopic and percutaneous approaches are often attempted, but the gold standard remains surgical biliary reconstruction, especially for refractory stricture. However, this solution leaves much room for improvement, due to the challenging nature of the biliary reconstr...

PURPOSE Recent studies have demonstrated that mineral and electrolyte abnormalities develop in patients who undergo bariatric surgery. While it is known that these abnormalities are a risk factor for urolithiasis, the prevalence of stone disease after bariatric surgery is unknown. We evaluated the likelihood of being diagnosed with or treated for an upper urinary tract calculus following Roux-e...