Society: SSAT

Classical gastrointestinal anastomoses have been made with sutures and/or metal staples, but have resulted in significant bleeding and leak rates. This video is demonstrating a compression anastomosis using magnets to achieve weight loss and remission of co-morbidities.
A linear magnet was delivered by flexible endoscopic catheter to a point 250 cm proximal to the ileocecal valve, and a second magnet was positioned in the first part of the duodenum; the bowel segments containing the magnets were apposed to initiate gradual incisionless compression. Laparoscopic assistance was used to obtain accurate bowel measurements, obviate tissue interposition, and close mesenteric defects.

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal neoplasms of the gastrointestinal tract with an annual incidence of 10-15 cases per million. Overall, they account for 0.1%-3.0% of all gastrointestinal tumors. GISTs take time to grow and become clinically expressed, therefore they are commonly an incidental finding. They appear throughout the gastrointestinal tract, however the most common site is the stomach followed by the small intestines, and rarely the rectum or esophagus. Gastroesophageal junction (GEJ) GISTs are extremely rare. We present a case of a unique resection, via DaVinci robot, of a GIST at the GEJ in a patient with type IV paraesophageal hernia.

We present a modification to a Laparoscopic Sleeve Gastrectomy (LSG) for the combined treatment of Class II obesity and an epiphrenic esophageal diverticulum in a patient with a relative contra-indication to a gastric bypass. The patient had a BMI of 39, ESRD on hemodialysis awaiting a Renal Transplant. A large epiphrenic diverticulum was found on endoscopy, and UGI Swallow confirmed a right posterolateral diverticulum, with preserved esophageal peristalsis. Technical highlights include hiatal and diverticulum dissection and diverticulectomy, Heller myotomy, Dor Fundoplication and hiatus closure. Lastly, the modified LSG preserving the part of the fundus used for the fundoplication.

Preoperative EndoFLIP was done to characterize the pylorus. The distensibility index (DI), minimum diameter (Dmin), and cross sectional area (CSA) were assessed and recorded at 40 and 50 mL fill volumes. Orise gel was then injected into submucosal space. Mucosal incision was made and submucosal plane was developed with monopolar cautery until duodenal fibers were seen over pyloric ridge. A retrograde circular myotomy was made with cautery. The mucosotomy was closed with running suture. Postoperatively, EndoFLIP was performed at the same site and volumes. The final DI, Dmin, and CSA at 50 mL increased from 6.7 to 7.5 mm2/mmHg (12%), 18.7 to 19.6 mm (5%), and 276 to 303 mm2 (10%) respectively

48 y/o male with several year history of chest discomfort, that became worse in the past 15 months. Postprandial pain was usually 4/10. The cardiac workup was negative for abnormalities.
EGD was normal. The patient had a CT ABD/PELVIS which showed celiac artery narrowing.
Patient had a celiac plexus block which relieved the pain for 4-6 hours .CTA showed moderate to high-grade narrowing of the proximal celiac trunk. Uneventful postoperative course. Denied nausea or vomiting. No further postprandial pain. Tolerated diet progressively. Discharged home on POD 1
Robotic-Assisted MALS release is a safe and effective procedure when significant narrowing of the celiac artery is observed.

alejandro Feria

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