Laparoscopic Removal of a Displaced Vertical Gastric Clip Causing Gastric Outlet Obstruction
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MULTIMEDIA ARTICLE
Laparoscopic Removal of a Displaced Vertical Gastric Clip Causing Gastric Outlet Obstruction Roberto de la Plaza Llamas 1 & Daniel A. Díaz Candelas 1 & José M. Ramia 1 Published online: 20 April 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Introduction Recently, some surgical teams have used a laparoscopic vertical clip gastroplasty to treat morbid obesity. This approach mimics the principle of laparoscopic sleeve gastrectomy, but using a completely reversible mechanism. Displacement of the device has been reported in 7.7% of cases. The manner of its withdrawal has not been described to date. Methods A 50-year-old woman with a body mass index (BMI) of 36.3 kg/m2 underwent a laparoscopic calibrated tubular gastroplasty at another hospital with an 38-F orogastric tube by a B-CLAMP® gastric clip on January 11, 2019. The patient came to the Emergency Department 8 months later due to complete oral intolerance, with continuous vomiting of 5 days of evolution. Physical examination: BMI 28.9 kg/m2, dehydration; depressed abdomen, with mainly supraumbilical pain and distension, and significant tympanism on palpation. No guarding or signs of peritoneal irritation. Simple abdominal x-ray showed gastric distension and gastric clip. The nasogastric tube drained 2500 cc of gastrobiliary contents. The computed tomography showed the gastric clip displaced and located medially to the esophagogastric junction, the lesser curvature, and the antropyloric region. Results A laparoscopic approach was performed using 4 trocars. Signs of gastric suffering in the antral region. The clip was located to the right of the lesser curvature covered by a layer of fibrosis. The clip was removed by a 12-mm trocar. There were no postoperative complications. Conclusion This video demonstrates a form to extract a displaced gastric clip used to create a calibrated tubular gastroplasty using a laparoscopic approach. Keywords Laparoscopic vertical clip gastroplasty . Gastric sleeve . Reversible bariatric surgery . Gastric clip . B-CLAMP®
Introduction Recently, some surgical teams have used a laparoscopic vertical clip gastroplasty to treat morbid obesity. This approach mimics the principle of laparoscopic sleeve gastrectomy, but Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-04606-0) contains supplementary material, which is available to authorized users. * Roberto de la Plaza Llamas [email protected] Daniel A. Díaz Candelas [email protected] José M. Ramia [email protected] 1
Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Calle Donante de sangre s/n., 19002 Guadalajara, Spain
using a completely reversible mechanism. The nonadjustable clip is placed vertically parallel to the lesser curvature [1, 2]. Its proponents claim that the clip restricts oral intake without changing small bowel anatomy, requires no stapling, causes no malabsorption, does not require any maintenance or surveillance, and is reversi
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