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Revista de residentes cirujanos Argentina

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Volume 1

HEPATOBILIARY-PANCREATIC

Abstract: Background: Currently, the need for conversion arises from two main causes: weight regain and gastroesophageal reflux disease (GERD). Occasionally, other indications—such as anastomotic stenosis—require conversion, with or without resection of the anastomotic complex, depending on the stenosed orifice. Objective: To demonstrate that conversion surgery from one-anastomosis gastric bypass (OAGB, formerly BAGUA) to Roux-en-Y gastric bypass (RYGB) can resolve early postoperative obstruction (refractory to medical therapy) due to stenosis of the outlet orifice to the alimentary limb. Design: Retrospective observational case report. Materials and Methods: A 31-year-old male (BMI 53), with hypertension (HTN) managed with enalapril and a maternal family history of adhesive syndrome, underwent multiple prior surgeries for peritoneal adhesions (enterolysis). Primary surgery: OAGB on 01/11/2022. Early reoperation: Readmitted at 48 hours post-op with acute obstructive abdomen. Revision surgery (04/11/2022): Refractory to medical therapy (steroids, prokinetics, NG tube). Diagnostic laparoscopy revealed stenosis of the alimentary limb outlet and severe dilation of the biliopancreatic limb. Conversion to RYGB with resection of the anastomotic complex was performed. Second reoperation (12/11/2022): Readmitted with acute abdomen; exploratory laparotomy showed multiple ileal adhesions (Douglas pouch), partial dehiscence of the entero-enteric anastomosis, and proximal small bowel dilation. Managed with open abdomen and visceral contact mesh after relaparotomy (72 hours later). Outcome: 14-day ICU stay + 1-week ward admission before discharge. Results: BAROS score: 6 months: Fair (1.5); 12 months: Very good (5.75); 24 months: Very good (6). HTN resolved (BP <140/90 mmHg, no medications). Conclusions: Conversion surgery is mandatory for early postoperative obstruction refractory to medical therapy. Patency testing localizes the obstruction site and anatomical cause. The surgical approach varies based on the affected orifice/limb. For alimentary limb outlet stenosis, conversion to RYGB may be definitive.

Authors: FERNANDO ÁLVAREZ

Keywords: BYPASS GÁSTRICO EN Y DE ROUX, BYPASS GÁSTRICO DE UNA ANASTOMOSIS, CIRUGÍA BARIÁTRICA Y METABÓLICA

Submission Date: 29 May 2025

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LIVER TRANSPLANTATION

Abstract: Background: Currently, the need for conversion arises from two main causes: weight regain and gastroesophageal reflux disease (GERD). Occasionally, other indications—such as anastomotic stenosis—require conversion, with or without resection of the anastomotic complex, depending on the stenosed orifice. Objective: To demonstrate that conversion surgery from one-anastomosis gastric bypass (OAGB, formerly BAGUA) to Roux-en-Y gastric bypass (RYGB) can resolve early postoperative obstruction (refractory to medical therapy) due to stenosis of the outlet orifice to the alimentary limb. Design: Retrospective observational case report. Materials and Methods: A 31-year-old male (BMI 53), with hypertension (HTN) managed with enalapril and a maternal family history of adhesive syndrome, underwent multiple prior surgeries for peritoneal adhesions (enterolysis). Primary surgery: OAGB on 01/11/2022. Early reoperation: Readmitted at 48 hours post-op with acute obstructive abdomen. Revision surgery (04/11/2022): Refractory to medical therapy (steroids, prokinetics, NG tube). Diagnostic laparoscopy revealed stenosis of the alimentary limb outlet and severe dilation of the biliopancreatic limb. Conversion to RYGB with resection of the anastomotic complex was performed. Second reoperation (12/11/2022): Readmitted with acute abdomen; exploratory laparotomy showed multiple ileal adhesions (Douglas pouch), partial dehiscence of the entero-enteric anastomosis, and proximal small bowel dilation. Managed with open abdomen and visceral contact mesh after relaparotomy (72 hours later). Outcome: 14-day ICU stay + 1-week ward admission before discharge. Results: BAROS score: 6 months: Fair (1.5); 12 months: Very good (5.75); 24 months: Very good (6). HTN resolved (BP <140/90 mmHg, no medications). Conclusions: Conversion surgery is mandatory for early postoperative obstruction refractory to medical therapy. Patency testing localizes the obstruction site and anatomical cause. The surgical approach varies based on the affected orifice/limb. For alimentary limb outlet stenosis, conversion to RYGB may be definitive.

Authors: JUAN PEKOLJ

Keywords: HÍGADO, TRASPLANTE HEPÁTICO, HEPATECTOMÍA.

Submission Date: 29 May 2025

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BARIATRIC

Abstract: Background: Currently, the need for conversion arises from two main causes: weight regain and gastroesophageal reflux disease (GERD). Occasionally, other indications—such as anastomotic stenosis—require conversion, with or without resection of the anastomotic complex, depending on the stenosed orifice. Objective: To demonstrate that conversion surgery from one-anastomosis gastric bypass (OAGB, formerly BAGUA) to Roux-en-Y gastric bypass (RYGB) can resolve early postoperative obstruction (refractory to medical therapy) due to stenosis of the outlet orifice to the alimentary limb. Design: Retrospective observational case report. Materials and Methods: A 31-year-old male (BMI 53), with hypertension (HTN) managed with enalapril and a maternal family history of adhesive syndrome, underwent multiple prior surgeries for peritoneal adhesions (enterolysis). Primary surgery: OAGB on 01/11/2022. Early reoperation: Readmitted at 48 hours post-op with acute obstructive abdomen. Revision surgery (04/11/2022): Refractory to medical therapy (steroids, prokinetics, NG tube). Diagnostic laparoscopy revealed stenosis of the alimentary limb outlet and severe dilation of the biliopancreatic limb. Conversion to RYGB with resection of the anastomotic complex was performed. Second reoperation (12/11/2022): Readmitted with acute abdomen; exploratory laparotomy showed multiple ileal adhesions (Douglas pouch), partial dehiscence of the entero-enteric anastomosis, and proximal small bowel dilation. Managed with open abdomen and visceral contact mesh after relaparotomy (72 hours later). Outcome: 14-day ICU stay + 1-week ward admission before discharge. Results: BAROS score: 6 months: Fair (1.5); 12 months: Very good (5.75); 24 months: Very good (6). HTN resolved (BP <140/90 mmHg, no medications). Conclusions: Conversion surgery is mandatory for early postoperative obstruction refractory to medical therapy. Patency testing localizes the obstruction site and anatomical cause. The surgical approach varies based on the affected orifice/limb. For alimentary limb outlet stenosis, conversion to RYGB may be definitive.

Authors: JOSÉ COOKE

Keywords: OBESIDAD, RECURRENCIA DE PESO, REFLUJO

Submission Date: 29 May 2025

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