#sleeve gastrectomy
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dr-chirag-thakkar · 1 month ago
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Sleeve Gastrectomy vs Gastric Bypass: What You Need to Know
Choosing between sleeve gastrectomy and gastric bypass surgery can be challenging. Both are effective for weight loss but work differently. Sleeve gastrectomy reduces stomach size to limit food intake, while gastric bypass changes the digestive system to cut calorie absorption. Each has its benefits and risks based on your health and goals. Read here to learn which is the best surgery between Sleeve Gastrectomy & Gastric Bypass for your weight loss journey.
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stargirl-power · 2 months ago
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On Weight Loss Surgery: three years later, pt. 2.
At some point I have to stop fussing and editing and actually post. Weight loss blog part 2, now live.
There are huge benefits to having the surgery but I would be lying if I said it was all sunshine and roses. Some drawbacks or things to be aware of are: Not everybody has as ‘successful’ an outcome as I did. Patients who have the sleeve can hope to lose 50-70% of their ‘excess weight’ where the excess is calculated as the weight over the goal weight, which itself is calculated as the weight…
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myrawjcsmicasereports · 2 months ago
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 Gastric Torsion following Sleeve Gastrectomy: A rare case and surgical management by Gustavo Adolfo Frontado Boada in Journal of Clinical Case Reports Medical Images and Health Sciences
Abstract
Gastric torsion is a rare but potentially life-threatening complication that can occur following sleeve gastrectomy, characterized by the rotation of the stomach along its axis. This case report presents the clinical presentation, diagnostic approach, surgical management, and postoperative outcomes of a patient who developed gastric torsion after previous sleeve gastrectomy. Early recognition and prompt surgical intervention are crucial in effectively managing this uncommon complication.
Keywords: Gastric torsion, Sleeve gastrectomy, Postoperative complication, Clinical presentation, surgical management.
Introduction
The increasing global prevalence of obesity has led to a higher demand for effective treatment options, with bariatric surgery emerging as a successful intervention for obesity and its associated comorbidities (8,9). Among various bariatric procedures, sleeve gastrectomy (SG) has gained widespread popularity, surpassing the Roux-en-Y gastric bypass (RYGB) as the most frequently performed bariatric surgery worldwide (3).
Although recent randomized controlled trials have indicated inferior long-term results for SG compared to RYGB, proponents of SG argue that its technical simplicity and lower risk of postoperative complications outweigh potential differences in long-term outcomes (5,7).
Nevertheless, like any surgical procedure, SG is not without potential complications. One such complication is gastric torsion, which can occur in individuals with laxity in gastric anatomical fixations, a history of prior abdominal operations (increasing the likelihood of peritoneal adhesions), or increased mobility of the stomach due to the release of the greater curvature from the greater omentum during SG (4).
Additionally, scar tissue formation, adhesions along the gastric tube, or incorrect technique, including improper sleeve configuration, can contribute to an increased risk of gastric rotation or twisting. These factors, combined with anatomical vulnerabilities, can lead to gastric torsion and result in varying degrees of obstruction, compromised blood supply, and potential ischemic damage to gastric tissue (4,6).
Case Report
A 39-year-old female with a preoperative body mass index (BMI) of 33 kg/m² underwent SG in another hospital as a primary weight loss procedure. The surgery was uneventful, and the patient was discharged on the third postoperative day. One month later, the patient presented to the emergency department of a peripheral hospital with repetitive vomiting, occurring approximately 15 times per day, along with persistent nausea. She was unable to tolerate any oral intake, including food and fluids.
Upon examination, the patient appeared dehydrated. Her vital signs were stable, but she exhibited signs of malnutrition and overall weakness. The abdomen was slightly distended and diffusely tender, with presence of bowel sounds. Laboratory analysis revealed leukopenia, iron deficiency anemia, as well as a deficiency in vitamin A. Initially, the patient was admitted to a peripheral hospital for further diagnostics and nutritional support. An upper gastrointestinal endoscopy and a barium swallow study of the upper gastrointestinal tract were performed, both of which revealed gastric torsion following the sleeve gastrectomy (Fig. 1).
Consequently, the patient was transferred to our center for further treatment. A laparoscopic revision was performed. Intraoperatively, a visible clockwise torsion of the proximal portion along the longitudinal axis of the gastric sleeve was observed, resulting from extensive and inflammatory adhesions to the pancreas (Fig. 2).
Despite the challenges, a 10 mm calibration tube was advanced by the anesthesia team with extensive manipulation using atraumatic forceps, allowing it to pass through the area into the duodenum. Subsequently, meticulous adhesiolysis was performed between the pancreas and gastric sleeve to completely free the sleeve while avoiding pancreatic injury. Laparoscopic scissors were predominantly used for the dissection. The gastric sleeve appeared relatively narrow overall. But, after releasing the torsion, a 12 mm calibration tube was easily advanced into the duodenum without any instrument manipulation, indicating the absence of remaining stenosis.
To prevent further adhesion and stabilize the gastric sleeve, available gastrosplenic ligament tissue was placed between the pancreas and the posterior wall of the gastric sleeve. Using a continuous suture with VicrylÒ 2-0, the gastrosplenic ligament was fixed longitudinally to the posterior wall of the gastric sleeve (Fig 3). Additional portions of the ligament were then fixed along the greater curvature using a continuous suture. This ensured a smooth, unobstructed course for the gastric sleeve without any torsion or constriction.
Postoperatively, the patient was closely monitored in the surgical peripheral ward, receiving appropriate intravenous fluids and analgesics. Over the course of five days, the patient's clinical condition improved rapidly, and she was able to tolerate oral intake. Follow-up imaging studies confirmed the patency of the gastric conduit and adequate gastric emptying.
Discussion
Gastric torsion is a rare complication following sleeve gastrectomy, with limited reports in the literature. The exact etiology of gastric torsion remains unclear, but factors such as anatomical variations, excessive gastric mobility, adhesions, improper sleeve configuration, and abnormal gastric motility have been suggested as potential contributing factors (4,6).
Various studies have reported the incidence of gastric torsion following sleeve gastrectomy, ranging from 1.23% to 2.5%. Clinical presentation can vary, from subacute symptoms and distention to acute-onset severe abdominal pain. Imaging studies, such as abdominal X-rays, contrast studies, or upper gastrointestinal endoscopy, can aid in the prompt diagnosis. In some cases, endoscopic treatments like balloon dilation or stents may be helpful, but surgical exploration seems to be crucial for definitive diagnosis and treatment (1,8).
Surgical management of gastric torsion involves untwisting the stomach and assessing its viability. If the stomach is viable, simple detorsion in some cases could be sufficient. However, a continuous suture fixation of the sleeve to the free edge of the gastrocolic ligament is recommended to decrease the risk of recrudescence (6).  If ischemic changes are present, partial or total gastrectomy may be required, depending on the extent of necrosis. Reconstruction options include gastrojejunostomy, gastroplasty, esophagogastrostomy or esophagojejunostomy.
Conclusion
Gastric torsion is a rare but potentially serious complication following sleeve gastrectomy. Early recognition and timely surgical intervention are essential for optimizing patient outcomes. Bariatric surgeons should maintain a high index of suspicion for gastric torsion in patients presenting with acute abdominal pain, food intolerance, and distention after sleeve gastrectomy. Further research is needed to elucidate the risk factors, preventive measures, and long-term outcomes associated with this rare complication.
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weightlosecenter · 2 months ago
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Best Sleeve Gastrectomy Surgeon in Delhi | Weight Loss Surgery at Weight Lose Clinic
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Are you struggling with weight loss despite trying various diets and exercise routines? Sometimes, traditional methods aren’t enough, and medical intervention becomes necessary. For those looking to transform their health, sleeve gastrectomy could be the solution. If you’re searching for the Best Sleeve Gastrectomy Surgeon in Delhi, you’re in the right place. At the Weight Lose Clinic, we specialize in providing life-changing weight loss surgery options tailored to your individual needs.
What is Sleeve Gastrectomy?
Sleeve gastrectomy is a type of weight loss surgery where a large portion of the stomach is removed, leaving a sleeve-like tube. This not only reduces the amount of food you can consume but also impacts the hormones that control hunger, helping you lose weight more effectively. It’s a minimally invasive procedure with proven results for long-term weight loss and improvement in obesity-related conditions like diabetes and high blood pressure.
Why Choose the Best Sleeve Gastrectomy Surgeon in Delhi?
Choosing the Best Sleeve Gastrectomy Surgeon in Delhi is essential for a successful surgery and optimal recovery. A highly skilled surgeon ensures the procedure is performed safely and with minimal complications. At the Weight Lose Clinic, our surgeons have extensive experience and use the latest techniques to ensure the best outcomes for their patients. We focus not just on the surgery but also on post-surgery care, including diet plans and regular check-ups to track your progress.
Benefits of Sleeve Gastrectomy
Effective Weight Loss: Most patients experience significant weight loss within the first year.
Improved Health: Conditions like type 2 diabetes, high blood pressure, and sleep apnea often improve after surgery.
Increased Confidence: As you lose weight and feel healthier, your confidence will naturally improve.
Why Choose Weight Lose Clinic?
The Weight Lose Clinic is known for offering comprehensive weight loss surgery in Delhi. Our team of experts provides personalized care, ensuring each patient receives the best possible treatment. With a focus on safety, we use cutting-edge technology and offer supportive post-operative care to help you achieve your weight loss goals.
If you’re considering weight loss surgery in Delhi, look no further than the Weight Lose Clinic for the Best Sleeve Gastrectomy Surgeon in Delhi. We are committed to helping you lead a healthier, happier life.
By focusing on key elements like the Best Sleeve Gastrectomy Surgeon in Delhi and expert care at the Weight Lose Clinic, you are one step closer to a successful weight loss journey!
Bariatric Surgeon in Delhi
Weight Lose Surgeon in Delhi
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safwantaha11 · 3 months ago
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Bariatric Surgery Abu Dhabi
When looking for the best bariatric surgeon in Abu Dhabi, it's important to consider the surgeon's experience, patient reviews, and the quality of care provided. One highly recommended bariatric surgeon in Abu Dhabi is Dr. Safwan Taha. He is the founder and CEO of the International Center for Bariatric and Metabolic Surgery (ICBMS), a specialized center that offers a wide range of weight loss surgery options, including gastric sleeve, gastric bypass, and revisional bariatric surgery.
Dr. Taha is known for his extensive experience, advanced surgical techniques, and patient-centric approach. You can find more information about his services and patient success stories on his website: Dr. Safwan Taha.
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slimthetics2024 · 3 months ago
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tods-drtulip-blog · 5 months ago
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Sleeve Gastrectomy Plus Procedures: A Comprehensive Guide
All we Know Sleeve gastrectomy, also known as gastric sleeve surgery, is a widely performed weight loss procedure. During the surgery, a significant portion of the stomach is removed, leaving behind a smaller, sleeve-shaped stomach. This reduced stomach capacity helps you eat less and feel less hungry by impacting your hormones. This blog take you to the Sleeve gastrectomy procedures.
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What is Sleeve Gastrectomy?
Sleeve gastrectomy, or gastric sleeve surgery, is a common weight loss procedure. In this surgery, a large part of the stomach is removed, leaving a smaller, sleeve-shaped stomach. This smaller stomach means you eat less and feel less hungry because it affects your hormones. It’s a good option for people with obesity, helping them improve their health and quality of life. Read more...
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obesity-reduction · 6 months ago
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Comparing Sleeve Gastrectomy to Other Bariatric Surgery
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Bariatric surgery is one of the most efficient ways of treating obesity and sleeve gastrectomy is one such type of bariatric surgery. During gastric sleeve surgery, a portion the stomach is removed which results in the remaining stomach has a much smaller capacity, which physically limits the amount of a person can consume at one time. Your remaining stomach is narrower, around the shape and size of a banana. This results in feeling full faster and allows you to control your hunger and eat less food.
In this blog we will explore the advantages of sleeve gastrectomy over other bariatric surgeries with insights from Dr.Shashank Shah:
Sleeve Gastrectomy vs Intragastric Balloon
As compared to the Gastric balloon, the sleeve gastrectomy leads to drastic weight loss. Sleeve gastrectomy is suitable for people who want to lose more than 40 pounds.
2. Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass Surgery (RYGB)
As compared to sleeve gastrectomy, Roux-en-Y Gastric Bypass Surgery (RYGB) is much more complex as it involves creating a small stomach pouch and rerouting the intestines. RYGB also bypasses a portion of the small intestine, potentially leading to a higher risk of nutritional deficiencies over time.
3.Sleeve Gastrectomy vs Mini Gastric Bypass
Sleeve gastrectomy is more simple than mini gastric bypass. This results in less complications during surgery. Also, the risk of dumping syndrome after mini gastric bypass is much greater than sleeve gastrectomy.
4.Sleeve gastrectomy vs Duodenal Switch
SG presents a reduced likelihood of nutritional deficiencies in contrast to DS. DS entails bypassing a substantial segment of the small intestine, potentially resulting in inadequate absorption of essential vitamins and minerals, thus requiring ongoing supplementation. SG is commonly viewed as being more easily reversible compared to DS. When necessary, SG can be transformed into DS or a different bariatric procedure, providing a range of treatment choices.
Dr. Shashank Shah is one of the best bariatric surgeons in Pune, India specializing in bariatric surgery. He has the following qualifications, M.B.B.S., M.S., FAIS, Honorary FMAS, Honorary FIAGES, Honorary FALS, Honorary FMBS, Dip. Visiting Prof. France, Medical Council Reg. №61837. He has more than 32 years of surgical experience
For more information contact, Laparo Obeso Centre,
+91–7277557755
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medicalprocare · 7 months ago
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Best Weight Loss Surgery Centre
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Why Choose Weightlose Clinic?
Expertise: The clinic is home to the best bariatric surgeon in Delhi, known for their extensive experience and successful track record in weight loss surgeries.
Advanced Techniques: Weightlose Clinic utilizes the latest surgical techniques and state-of-the-art technology to ensure the best outcomes for patients.
Comprehensive Care: From initial consultation to post-operative support, the clinic provides a full spectrum of care tailored to each patient’s needs.
High Success Rates: Known as the best weight loss surgery centre, the clinic boasts high success rates and numerous satisfied patients.
Personalized Treatment Plans: Each patient receives a customized treatment plan, ensuring the most effective approach to weight loss.
Success Stories from Dr Tarun Mittal’s Practice
Aarti’s New Beginning
Aarti, a 32-year-old software developer, had battled with her weight for nearly a decade, severely affecting her mobility and overall health. After her weight peaked at 140 kg, she consulted Dr. Mittal. Post gastric sleeve surgery, Aarti lost an incredible 60 kg over the next year. Today, she leads a healthier, more active lifestyle and has regained confidence in both her personal and professional life.
Rohan’s Victory Over Diabetes and Obesity
Rohan, a 45-year-old businessman, suffered from type 2 diabetes due to obesity. Weighing 130 kg, he struggled with daily activities and managing his diabetes. Dr. Mittal recommended gastric bypass surgery, known for its effectiveness in treating obesity-related diabetes. The results were phenomenal. Rohan lost 55 kg, and his diabetes went into remission. He no longer needs insulin and has embraced a healthier lifestyle with renewed vigor.
Meera’s Journey to Motherhood
Meera, a 29-year-old who had been trying to conceive for years due to complications from her weight, turned to Dr. Mittal for help. Weighing 118 kg, her obesity was a barrier to her dream of becoming a mother. Six months after laparoscopic bariatric surgery, Meera lost 40 kg and soon conceived naturally. Today, she is a proud mother to a healthy baby girl.
Treatment Options at Weightlose Clinic
Here are some of the treatment options provided by Weightlose Clinic:
Gastric Bypass Surgery: This procedure alters the stomach and digestive system to limit food intake and nutrient absorption, leading to significant weight loss.
Sleeve Gastrectomy: Performed by expert sleeve gastrectomy surgeon in Delhi, this surgery involves removing a portion of the stomach, resulting in a smaller, sleeve-shaped stomach that restricts food intake.
Adjustable Gastric Banding: In this procedure, a band is placed around the upper part of the stomach to create a small pouch, limiting food intake and promoting weight loss.
Biliopancreatic Diversion with Duodenal Switch (BPD/DS): This complex surgery combines a sleeve gastrectomy with a bypass of the majority of the intestine, significantly limiting calorie absorption and promoting substantial weight loss.
Revisional Bariatric Surgery: These procedures are designed to correct or modify previous bariatric surgeries, enhancing outcomes and addressing any complications.
Choosing Weightlose Clinic means opting for the best weight loss surgery centre with the most qualified professionals, including the best bariatric surgeon in Delhi and leading sleeve gastrectomy surgeon in Delhi. The clinic’s dedication to patient care, advanced surgical options, and high success rates make it the top choice for individuals seeking effective and lasting weight loss solutions.
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dr-chirag-thakkar · 2 months ago
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Sleeve Gastrectomy in Ahmedabad: Choosing the Right Surgeon
Choosing the right surgeon for a sleeve gastrectomy in Ahmedabad is crucial for successful surgery and good weight loss results. Focus on the surgeon’s experience, board certifications, patient reviews, and connections with reputable hospitals. A well-experienced surgeon provides better pre-op guidance, precise surgery, and reliable post-op care, minimizing risks and improving results. Read here to learn more about choosing the right surgeon for sleeve gastrectomy.
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healthcaremedical12 · 9 months ago
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Why Choose Us for Your Weight Loss Surgery Needs?
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Expertise in Sleeve Gastrectomy Surgery
Our experienced bariatric surgeons specialize in  Sleeve Gastrectomy Surgeon in Delhi A highly effective weight loss surgery that reduces the size of the stomach and helps patients achieve significant weight loss. With our expertise in this procedure, you can trust us to deliver safe and successful outcomes.
Comprehensive Weight Loss Solutions
We offer a range oF Weight Lose Surgery in Delhi options tailored to meet your unique needs and goals. Whether you're considering sleeve gastrectomy, gastric bypass, or another bariatric procedure, our team will work closely with you to determine the best approach for your individual circumstances.
Personalized Care and Support
At the Weight Loss clinic, we prioritize personalized care and support for each of our patients. From your initial consultation to post-surgery follow-up appointments, our compassionate team will be by your side every step of the way, providing guidance, encouragement, and assistance as needed.
What Sets Us Apart as the Best Bariatric Surgeon in Delhi NCR?
Exceptional Surgical Skill and Experience
Our bariatric surgeons are highly skilled and experienced in Dr Tarul Mittal  performing complex weight loss procedures with precision and expertise. With years of specialized training and a commitment to excellence, they have earned a reputation for delivering exceptional results.
State-of-the-Art Facilities
We operate in modern, state-of-the-art facilities equipped with the latest surgical technologies and amenities to ensure the highest standards of safety, comfort, and patient care. You can rest assured that you'll receive top-quality treatment in a supportive and welcoming environment.
Proven Track Record of Success
Our clinic has a proven track record of success in helping patients achieve their weight loss goals and improve their overall health and well-being. We take pride in our consistently positive outcomes and the life-changing transformations we facilitate for our patients.
Ready to Take the Next Step?
If you're ready to take control of your weight and improve your health through bariatric surgery, we're here to help. Contact us today to schedule a consultation with the best bariatric surgeon in Delhi NCR and learn more about your options for weight loss surgery.
Don't let excess weight hold you back any longer. Take the first step toward a healthier, happier you by choosing our clinic for your bariatric surgery needs. We look forward to assisting you on your weight loss journey!
Frequently Asked Questions About Bariatric Surgery
What is bariatric surgery?
Bariatric Surgery For Weight Loss in Delhi is a surgical procedure designed to help individuals lose weight by altering the digestive system's anatomy. It is typically recommended for individuals who are severely obese and have not been successful with traditional weight loss methods.
What are the different types of bariatric surgery?
There are several types of Bariatric Surgery For Weight Loss in Delhi, including sleeve gastrectomy, gastric bypass, gastric banding, and biliopancreatic diversion with duodenal switch. Each procedure has its own benefits and considerations, and the best option for you will depend on your individual health needs and goals.
What is sleeve gastrectomy surgery?
Sleeve gastrectomy surgery, also known as vertical sleeve gastrectomy, involves removing a large portion of the stomach to create a smaller, banana-shaped stomach pouch. This reduces the stomach's capacity, leading to decreased food intake and ultimately weight loss. Sleeve gastrectomy is a popular and effective bariatric procedure that can help patients achieve significant and sustained weight loss.
Am I a candidate for bariatric surgery?
Candidates for bariatric surgery typically have a body mass index (BMI) of 40 or higher, or a BMI of 35 or higher with obesity-related health conditions such as diabetes, hypertension, or sleep apnea. However, eligibility criteria may vary depending on individual circumstances and the specific requirements of the surgical center.
What are the benefits of bariatric surgery?
Bariatric surgery offers numerous benefits beyond weight loss, including improvement or resolution of obesity-related health conditions such as type 2 diabetes, high blood pressure, and obstructive sleep apnea. Additionally, many patients experience enhanced quality of life, increased mobility, and improved self-esteem following surgery.
Is bariatric surgery safe?
Bariatric surgery is generally considered safe and effective for eligible candidates when performed by experienced surgeons in accredited facilities. However, like any surgical procedure, there are potential risks and complications, including infection, bleeding, and nutritional deficiencies. It is essential to discuss the potential risks and benefits of bariatric surgery with your healthcare provider before making a decision.
What is the recovery process like after bariatric surgery?
The recovery process after bariatric surgery varies depending on the type of procedure performed and individual factors. In general, patients can expect to stay in the hospital for a few days following surgery and gradually resume normal activities over several weeks. Following Best Bariatric Surgeon in Delhi NCR patients will need to follow a specific diet and exercise regimen to support weight loss and promote healing.
How long does it take to see results after bariatric surgery?
Weight loss following bariatric surgery typically occurs gradually over several months to a year, with the most significant weight loss typically occurring in the first six to twelve months after surgery. However, individual results may vary, and it is essential to follow your surgeon's recommendations for diet, exercise, and follow-up care to maximize weight loss and maintain long-term success.
Also Read
Sleeve Gastrectomy Surgeon in Central Delhi
Best Bariatric Surgeon in Rajinder Nagar
Obesity Surgeon in Sir Ganga Ram Hospital
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dr-mohamed-ismail · 11 months ago
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A Guide to Choosing the Right Surgeon and Team for Laparoscopic Sleeve Gastrectomy in Kerala
Undergoing laparoscopic sleeve gastrectomy surgery is a life-changing decision, and finding the right surgeon and team to guide you is very important. This critical choice impacts your entire experience, from initial consultation and surgery to post-operative care and long-term success.
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Kerala, India, has emerged as a hub for medical tourism, renowned for its advanced medical facilities, skilled surgeons, and affordable costs. With so many choices available, navigating the selection process can feel overwhelming. Here's a road map to help you find the perfect surgeon and team for your needs:
Research and compare
Qualifications and Experience: Prioritize surgeons who are certified in laparoscopic surgery and experienced specifically in sleeve gastrectomy.
Patient Testimonials and Reviews: Authentic patient experiences offer valuable insights. Read online reviews and testimonials, seeking feedback on the surgeon's bedside manner, surgical skill, and overall patient satisfaction.
Hospital Facilities and Team: Consider the hospital's infrastructure, equipment, and the expertise of the supporting team, including anesthesiologists and nurses.
2. Schedule consultation
Once you've narrowed down your options, schedule consultations with the shortlisted surgeons. This is your chance to ask questions, understand their approach, and measure their commitment to your individual needs.
3. Trust your Feelings
Ultimately, choosing the right surgeon is about more than just qualifications. Pay attention to your intuition and comfort level. Do you feel heard and understood? Does the surgeon provide you with the confidence to approach the surgery?
Dr. Mohamed Ismail has all the qualities you seek in a surgeon. His extensive experience, proven track record of successful sleeve gastrectomy procedures, and continuous commitment to patient well-being make him a top choice for individuals seeking this life-changing surgery in Kerala.
Visit our website to learn more about us.
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weightlosecenter · 3 months ago
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mdbariatrics · 1 year ago
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Looking to achieve lasting weight loss and improved health? Bariatric surgeries in Maryland are here to help you reach your goals. Their specialist team provides safe, effective procedures with customized care plans tailored to your needs. Visit now to know more.
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safwantaha11 · 3 months ago
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Dr. Safwan Taha: Specialist in Multimodal Obesity Treatment
Discover top-tier Obesity and Weight Loss Surgery in Abu Dhabi with Dr. Safwan Taha. We specialize in Bariatric and Metabolic Surgery and offer personalized care to help you achieve your health goals. Whether you need Sleeve Gastrectomy, Gastric Balloon, or other weight loss solutions, our expert team provides comprehensive support throughout your journey. Contact us for the best Bariatric Surgery Abu Dhabi has to offer. Achieve your weight loss goals with the best in Abu Dhabi.For advanced Obesity management and transformative results in Abu Dhabi, trust the expertise of Dr. Safwan Taha.
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trenetralaya · 1 year ago
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