Bariatric surgery was shown to be the only way to achieve sustainable weight loss and to decrease the frequency and severity of metabolic and cardiovascular comorbidities[ 2 ]. Laparoscopic adjustable gastric band LAGB is in many countries, especially in Europe and Australia[ 3 ], the most frequently used technique[ 2 ], even though others such as the Roux-en-Y gastric bypass or biliopancreatic diversion are still performed[ 2 ].
The mortality rate in bariatric surgery is between 0. The mortality is increased if revision surgery is needed[ 6 ].
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The purpose of this article is to present a potential complication of abdominal surgery re-entry for gastric band correction at the level of the aorta having in the end a lethal outcome.
The patient was released from the hospital after three days. After about four months she was admitted again, with an initial diagnosis of superior digestive hemorrhage and status post gastric banding.
Radiological examination revealed an anteriorly malrotated ring, intraparietal filling with a radiopaque material, and a small retro-parietal fistula in cât timp să piardă grăsimea abundentă gastric fundus.
As the patient presented superior digestive hemorrhage and ring malrotation a surgical intervention was performed, whose aim was to extract the band.
Laparoscopy was performed with the trocars located above the umbilicus, in the left flank, left and right hypochondriac area, and in weightloss resources greutate convertor epigastrium.
During the surgical intervention, the rubber hose of the ring was weightloss resources greutate convertor a severe inflammatory reaction, incorporating the abdominal esophagus, the cardiac area of the stomach, and the celiac region.
A difficult sharp dissection was started for viscerolysis; while trying to mobilize the ring that was identified red, arterial blood flowing through the nasogastric tube.
The procedure was immediately converted to a xiphoid-umbilical laparotomy associated with gastrotomy step in which were evacuated large blood clots from the stomach; the source of bleeding was found to be a laceration of about two centimeters at the anterior part of the aorta, located posteriorly from the esophagus.
At the same time the anesthetic team, noticing ml of fresh blood in the aspirator of the gastric content started the resuscitation protocol. After laparotomy, another ml fresh blood was aspirated from the surgical field.
There was not an available cell saver in the operating room. Due to the severity of the intraoperative incident, together with the scarce reserve of the hospital blood supplies, the patient received only four units of packed red blood cells and five units of fresh frozen plasma.
Aortic rupture during reoperative bariatric surgery
The laceration was sutured but the blood losses were too great and the patient died of hemorrhagic shock, unresponsive to resuscitation maneuvers. Autopsy findings On the anterior side of the lower part of the thoracic weightloss resources greutate convertor, near the diaphragm, an H laceration of about 1. On the posterior side of the aorta, corresponding to the anterior lesion, a small laceration of about 0.
In the stomach, a callous ulcer near the pyloric antrum was identified on the posterior gastric wall, with rounded margins, affecting the mucosal, submucosal and muscular layer, with a diameter of about 1. The esophagus in the subdiaphragmatic part, near the cardia, had an anfractuous laceration, affecting all the anatomical layers, with a sutured hemorrhagic infiltrate.