2nd IFSO MENAC Teleconference. Difficult Bariatric Cases
On the first case presented by Dr. Haddad, the question raises before a malnourished patient after a one anastomosis gastric bypass or a minigastric bypass who has an anastomotic perforation. Dr. Haddad presented the full case and asking to the audience whether they would repair the perforation only, reverse the bariatric operation or converting into a Roux-en-Ygastric bypass. Expert opinions as well as surgical video are shown throughout the panel discussion.
Second case presents a patient planned for sleeve gastrectomy where a large hiatal hernia is evidenced. First Dr. Hayssam asks the audience if routine pre-operative endoscopy should be performed, and second he proposed either abort the surgery, proceed with a sleeve with a hiatal hernia repair with or without mesh, a Roux-en-Y gastric bypass or a mini gastric bypass. Discussion of the literatura and videos support the final surgical decision.
Finally, Dr. Al Hadad brings up the discussion by presenting a case where there were unexpected findings of a prior POSE procedure when the patient had denied any prior surgical procedures. Since the risks of the possible surgical procedure increase, ethical concerns should be raised and therefore this should be discussed with the patient and/or family prior to continue.