In 1991, the author (H.Y.S.) reported the first case of self-expandable metallic stent (SEMS) placement in a patient with recurrent cancer after gastrojejunostomy. Since then SEMS placement has developed into a well-established method for the palliative treatment of malignant gastroduodenal obstruction. This year marks the 30th year the author has been implicated in the development of gastrointestinal SEMSs. Thus far, the author has developed successively a total of six generations of gastroduodenal SEMSs through trial and error over the years. In the present article, the author reviews his personal experience in developing gastroduodenal stents.
Family Characteristics ; Gastric Bypass ; Humans ; Methods ; Palliative Care ; Stents*

Enteroenteric anastomotic strictures of UGI tract are common and require treatment if significant obstruction occurs. We performed fluoroscopic guided balloon dilatation in 6 patients who had symptomatic stricture of gastrojejunostomy. The stricture was successfully resolved in 4 patients with benign stricture. But 2 patients with malignant stricture had recurrence of obstructive symptom 2 weeks later, and they required a stent. Asymptomatic balloon rupture was seen in one patient, but other procedural complications did not occur. We found that fluoroscopic guided balloon dilatation is an effective and safe method in the treatment of anastomotic stricture of gastrojejunostomy. We also found transient effect in malignant gastrojejunal anastomotic strictures, which required an interventional procedure, such as placement of a stent.
Constriction, Pathologic* ; Dilatation* ; Gastric Bypass* ; Humans ; Methods ; Recurrence ; Rupture ; Stents

Enteroenteric anastomotic strictures of UGI tract are common and require treatment if significant obstruction occurs. We performed fluoroscopic guided balloon dilatation in 6 patients who had symptomatic stricture of gastrojejunostomy. The stricture was successfully resolved in 4 patients with benign stricture. But 2 patients with malignant stricture had recurrence of obstructive symptom 2 weeks later, and they required a stent. Asymptomatic balloon rupture was seen in one patient, but other procedural complications did not occur. We found that fluoroscopic guided balloon dilatation is an effective and safe method in the treatment of anastomotic stricture of gastrojejunostomy. We also found transient effect in malignant gastrojejunal anastomotic strictures, which required an interventional procedure, such as placement of a stent.
Constriction, Pathologic* ; Dilatation* ; Gastric Bypass* ; Humans ; Methods ; Recurrence ; Rupture ; Stents

PURPOSE: Roux-en-Y reconstruction (RY) in laparoscopic distal gastrectomy for gastric cancer is a more complicated procedure than Billroth-I (BI) or Billroth-II. Here, we offer a totally laparoscopic simple RY using linear staplers. MATERIALS AND METHODS: Each 50 consecutive patients with totally laparoscopic distal gastrectomy with RY and BI were enrolled in this study. Technical safety and surgical outcomes of RY were evaluated in comparison with BI. RESULTS: In all patients, RY gastrectomy using linear staplers was safely performed without any events during surgery. The mean operation time and anastomosis time were 177.0+/-37.6 min and 14.4+/-5.6 min for RY, respectively, which were significantly longer than those for BI (150.4+/-34.0 min and 5.9+/-2.2 min, respectively). There were no differences in amount of blood loss, time to flatus passage, diet start, length of hospital stay, and postoperative inflammatory response between the two groups. Although there was no significant difference in surgical complications between RY and BI (6.0% and 14.0%), the RY group showed no anastomosis site-related complications. CONCLUSION: The double stapling method using linear staplers in totally laparoscopic RY reconstruction is a simple and safe procedure.
Aged ; Female ; Gastrectomy/*methods ; Gastric Bypass/*methods ; Humans ; Laparoscopy/*methods ; Male ; Middle Aged ; Stomach Neoplasms/surgery

Bariatric surgery is an effective way to achieve long-term weight reduction in severely obese patients. This article illuminates the indications, procedures, complications, and results of bariatric surgery for severe obesity.
Bariatric Surgery ; methods ; Gastric Bypass ; methods ; Gastroplasty ; methods ; Humans ; Obesity, Morbid ; surgery

BACKGROUNDGastrojejunostomy is one of the most frequently used procedures for general surgeons. The creation of anastomosis between various parts of the gastrointestinal tract is a basic technical component and major task in the daily practice of almost all gastrointestinal procedures. This research evaluated a new procedure of making gastrointestinal anastomosis with stent.

METHODSTwenty experimental mini-pigs were randomized into two groups. In stent anastomosis group (SA), the anastomoses were constructed with a poly-levolactic acid stent. In hand-sewn group (HA), the anastomoses were performed with a single-layer continuous suture. Abdominal X-ray with intraluminal contrast was performed on the 10th postoperative day. Five pigs of each group were sacrificed on the postoperative days 3 and 14 to determine anastomotic bursting pressure in situ, hydroxyproline concentration, and histopathological evaluation of the anastomotic sites.

RESULTSThere was no intraoperative morbidity or mortality. The median time needed for the sutured anastomosis was (21.7 ± 2.3) minutes and for the stent anastomosis was (11.9 ± 1.9) minutes (P < 0.001). Abdominal X-ray with intraluminal contrast demonstrated normal gas distribution and showed no evidence of leakage or obstruction. Macroscopic appearance at the longitudinal opening of anastomosis was always good in both groups. The median anastomotic bursting pressure was (18.2 ± 1.6) kPa in SA group on postoperative day 3, compared with (11.7 ± 3.2) kPa in HA group (P = 0.003). The anastomotic bursting pressure on day 14 was not significantly different between SA group ((27.1 ± 2.6) kPa) and HA group ((28.3 ± 1.7) kPa) (P = 0.388). The hydroxyproline concentrations were not significantly different.

CONCLUSIONSThe stent anastomosis was not considered to be more difficult than a sutured anastomosis. This method is proved to be safe and feasible compared with the traditional hand-sewn method in the porcine model. The method increases early anastomotic strength in this study.

Anastomosis, Surgical ; methods ; Animals ; Female ; Gastric Bypass ; methods ; Hydroxyproline ; metabolism ; Male ; Stents ; Swine

BACKGROUND/AIMS: Currently, a new over-the-scope clip (OTSC) system has been introduced. This system has been used for gastrointestinal perforations and fistulas in other countries. The aim of our study is to examine the therapeutic success rate of endoscopic treatment using the OTSC system in Korea. METHODS: This was a multicenter prospective study. A total of seven endoscopists at seven centers performed this procedure. RESULTS: A total of 19 patients were included, with gastrointestinal leakages from anastomosis sites, fistulas, or esophageal perforations due to Boerhaave’s syndrome. Among these, there were three gastrojejunostomy sites, three esophagojejunostomy sites, four esophagogastrostomy sites, one esophagocolonostomy site, one jejuno-jejunal site, two endoscopic full thickness resection site closures, one Boerhaave’s syndrome, two esophago-bronchial fistulas, one gastrocolonic fistula, and one colonopseudocyst fistula. The size of the leakage ranged from 5 to 30 mm. The median procedure time was 16 min. All cases were technically successful. Complete closure of the leak was achieved in 14 of 19 patients using OTSC alone. CONCLUSIONS: The OTSC system is a safe and effective method for the management of gastrointestinal leakage, especially in cases of anastomotic leakage after surgery.
Anastomotic Leak ; Esophageal Perforation ; Fistula ; Gastric Bypass ; Humans ; Korea ; Methods ; Prospective Studies

In 2001, Rutledge reported the first case of mini gastric bypass (MGB). Carbajo improved the technique of MGB and named it one anastomosis gastric bypass (OAGB). Over the past 20 years, a large number of clinical and basic studies on OAGB/MGB have been reported, and the answers to some key questions about OAGB/MGB have gradually become clear. From a technical point of view, MGB and OAGB can be regarded as two subvariants of one surgery. The advantages of OAGB/MGB include: (1) simplicity, safety and lower probability of internal hernia;(2) stable and durable weight reduction effect; (3) stable and durable remission rate of type 2 Diabetes. The disadvantages of OAGB/MGB include: (1) bile reflux; (2) higher risk of malnutrition. OAGB/MGB has achieved a good balance between effectiveness and safety, and has become the most noticed and fastest-growing bariatric and metabolic procedure in recent years. OAGB/MGB has been recommended as a standard bariatric and metabolic procedure by IFSO and ASMBS.
Diabetes Mellitus, Type 2/surgery* ; Gastric Bypass/methods* ; Humans ; Obesity, Morbid/surgery* ; Retrospective Studies ; Weight Loss

Laparoscopic Roux-en-Y gastric bypass (LRYGB) has become the gold standard operation for morbid obesity, because effects of LRYGB are quick and lasting. However, there are many potential risks due to the operative complexity and long learning curve. There are early and late complications after LRYGB. If the complications are not diagnosed and treated in time and correctly, serious results even death, may occur. Mortality after LRYGB is 0.87%. It is important for the continous and healthy development of LRYGB that postoperative complications can be diagnosed and managed in time and effectively.
Gastric Bypass ; adverse effects ; methods ; Humans ; Laparoscopy ; adverse effects ; methods ; Obesity, Morbid ; surgery ; Postoperative Complications ; diagnosis ; therapy

At present, sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) have become the major bariatric and metabolic surgical procedures, but neither of them is perfect. Adding jejunojejunal bypass (JJB) to SG can enhance weight loss and hypoglycemic effect. Present clinical results show that the short-term weight loss effect of SG-JJB is better than SG, and the weight loss and hypoglycemic effect is similar to RYGB. However, SG-JJB does not have various complications like traditional jejunal ileal bypass (JIB). The existing evidence shows that SG-JJB is a safe and effective bariatric and metabolic surgery, with relatively simple technical requirement. Meanwhile, SG-JJB has almost no dumping syndrome or ulcers, and facilitates endoscopic examination of the biliary tract, and has no blind gastric pouch. Thus, SG-JJB has some clinical application prospects, but further high-quality research with long-term follow-up is needed.
Gastrectomy/methods* ; Gastric Bypass/methods* ; Humans ; Hypoglycemic Agents ; Obesity, Morbid/surgery* ; Retrospective Studies ; Treatment Outcome ; Weight Loss