Department of Gynecology, Obstetrics and Neonatology, Medical University of Gdansk, Gdańsk, Poland.
University Clinical Centre in Gdansk, Gdańsk, Poland.
Obes Surg. 2024 Nov;34(11):4263-4266. doi: 10.1007/s11695-024-07521-w. Epub 2024 Oct 5.
This case report describes a pregnant woman who underwent a laparoscopic MiniMizer Gastric Ring procedure for clinically severe obesity only one month before conception. At 31 weeks of gestation, the patient as admitted to the hospital with postprandial vomiting and persistent left-sided colicky abdominal pain. Maternal abdominal MRI revealed an intestinal obstruction and elective surgery was recommended. Due to the considerable risk to the fetus, antenatal corticosteroids were immediately administered to promote lung maturation and magnesium sulfate was started for fetal neuroprotection. During an exploratory laparoscopy, significantly enlarged and ischemic intestinal loops were found, leading to the decision to perform an atraumatic "en caul" cesarean delivery. After a successful "en caul" delivery, the MiniMizer ring, which had dislodged downwards and led to mesenteric ischemia, was visualized. Intraoperative esophagogastroduodenoscopy revealed a 1cm defect in the stomach wall related to gastric ring, covered with purulent exudate. Further exploration, showed a herniation of the distal alimentary loop through the Petersen foramen. Successful management included ring removal and intestinal loop reduction from the Petersen's space, without evidence of strangulation, as confirmed with indocyanine green (ICG) angiography. The postoperative course was uneventful. Women with obesity who have undergone bariatric surgery should to be informed of the increased likelihood of becoming pregnant after treatment. It is advised to notify the patient of the importance of maintaining a sufficient interval between bariatric surgery and conception. Additionally reports from the literature on various complications during pregnancy after bariatric surgery are presented.
本病例报告描述了一位孕妇，她在受孕前一个月仅因临床严重肥胖而行腹腔镜 MiniMizer 胃环手术。妊娠 31 周时，患者因餐后呕吐和持续性左侧绞痛性腹痛入院。母体腹部 MRI 显示肠梗阻，建议行择期手术。由于对胎儿的风险较大，立即给予产前皮质激素以促进肺成熟，并开始使用硫酸镁进行胎儿神经保护。在腹腔镜探查时，发现明显扩大和缺血的肠袢，决定进行无创伤的“en caul”剖宫产。“en caul”分娩成功后，发现向下移位导致肠系膜缺血的 MiniMizer 环。术中食管胃十二指肠镜检查显示与胃环相关的胃壁有 1cm 缺损，覆盖脓性渗出物。进一步探查显示，远端消化道袢通过 Petersen 孔疝出。成功的治疗方法包括从 Petersen 空间取出环和减少肠袢，没有绞窄的证据，吲哚菁绿（ICG）血管造影证实了这一点。术后过程顺利。接受过减重手术的肥胖女性应被告知治疗后怀孕的可能性增加。建议告知患者在减重手术和受孕之间保持足够间隔的重要性。此外，还报告了文献中关于减重手术后妊娠期间各种并发症的情况。
