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video (2)

Laparoscopic loop duodenal switch

Contributors: Jeremy Slawin and George Fielding Revisional surgery after laparoscopic sleeve gastrectomy (LSG) is sometimes needed to manage complications of the procedure, in particular, weight loss failure. Several surgical options exist for revision including repeat sleeve gastrectomy (“re-sleeve”), placement of an adjustable gastric band around the sleeve, conversion to Roux-en-Y gastric bypass or conversion to biliopancreatic diversion-duodenal switch. The loop duodenal switch is a modification of the duodenal switch procedure whereby a malabsorptive component is added to improve weight loss but the procedure is simplified by having only one intestinal anastomosis. The patient presented is a 63-year-old male with a past medical history of coronary artery disease, diabetes mellitus type II, hyperlipidemia and morbid obesity. He had undergone LSG over a 36 French bougie at an outside institution two years prior. His past surgical history was also notable for previous laparoscopic ventral hernia repair and laparoscopic transabdominal inguinal hernia repair. The patient had lost weight after his LSG but had regained a significant amount, with worsening of his diabetes. His Body Mass Index (BMI) at revision is 37.7kg/m2.

Laparoscopic Common Bile Duct Exploration for Mirizzi Syndrome: Technical Tips

Mirizzi syndrome, the mechanical obstruction of the common hepatic duct secondary to extrinsic compression of stones impacted in the gallbladder neck or the cystic duct, is a rare complication of cholelithiasis (0.2% to 1.5% of patients). Up to 50% of patients are diagnosed intra-operatively.

We describe technical tips of laparoscopic treatement of Mirizzi Syndrome, including laparoscopic cholecystectomy, common bile duct exploration and stone extraction. Often it is best to fashion the ductotomy over the palpable stone. T tube cholangiogram is also invaluable.

In conclusion, laparoscopic treatment may be used for Mirizzi Syndrome.

Contributor:Dr. Manish Parikh

leadership (1)

H. Leon Pachter, MD

George David Stewart Professor of Surgery, Chair of the Department of Surgery at NYU Langone Medical Center

Known for his passion, energy, and skill, Dr. Pachter has perfected a number of life-saving techniques over the years, including a multidisciplinary approach to treating tumors of the adrenal gland. By introducing advances in minimally invasive surgical techniques, Dr. Pachter has played a key role in making NYU Langone’s surgical service one of the finest in the country. Dr. Pachter is also a world-renowned educator, whose mentees have become national leaders at other prestigious medical centers.

Dr. Pachter’s roots to NYU Langone stretch back to his days as a student and chief resident in the early 1970s. After completing his MD, residency, and American Cancer Society Fellowship at NYU School of Medicine, Dr. Pachter has had an unbroken record of outstanding contributions—as director of the Trauma Service at Bellevue Hospitals Center from 1978 to 1998; as executive director from 1999 to 2006; as director of Bellevue’s Surgical Intensive Care Unit from 1978 to 1997; as chairman of the Medical Board of Tisch Hospital; as vice chairman for Faculty Affairs; as division chief of General Surgery; and as author, clinical scientist, master laparoscopic surgeon, and world-class mentor. Additionally, Dr. Pachter was instrumental in garnering significant support from the city council to build the Ranson laboratory at Bellevue Hospital, a site of important cancer research investigations.

The author of more than 100 peer-reviewed publications and numerous book chapters, Dr. Pachter serves on the Editorial Board for the American Journal of Surgery, Annals of Surgery and The Journal of Trauma and Critical Care. He also served on the American Board of Surgery as a consultant for the written boards for 8 years and is currently serving on the membership committee of the American Surgical Association. The American College of Surgeons has also designated him a mentor for young female academic surgeons in the U.S. This year Dr. Pachter was chosen by the Society of Black Academic Surgeons for its 2015 fellowship award for his efforts to diversify his department and his seminal contributions to surgery.

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