Laparoscopic sleeve gastrectomy (LSG), first intended as the first step of biliopancreatic diversion with duodenal switch (BPD-DS), is gaining popularity as a per-se procedure because of its effectiveness on weight loss and comorbidity resolution. The extraction of the gastrectomy specimen could be challenging and time-consuming. Different techniques have been described for specimen withdrawal. In this article we report the technique adopted in more than 250 LSGs performed in our department.
In the first 90 LSGs performed in our department from October 2002, the specimen was extracted in a retrieval bag using an endoloop. In the following 160 cases the technique has been simplified: the grasped specimen is withdrawn through the 15-mm trocar site without any additional device.
We registered only two cases of wound infection (1.2%) with the simplified technique, both occurring in the initial cases. There were no cases of trocar site hernia formation.
The technique described does not require any special devices and seems to be simpler, saves time, and is cost effective if compared with other techniques previously reported.
"But in our experience, meticulous gastric fundus dissection, accurate placement of the bougie against the lesser curve, and stretching of the gastric walls during the resection are the most important factors in determining the capacity of gastric remnant. The specimen was extracted directly through the right subcostal trocar site and the trocar sites closed by using the Bercy needle when blade trocar is positioned to avoid trocar site hernia  "
[Show abstract][Hide abstract] ABSTRACT: Background. Laparoscopic gastric sleeve (LGS) has been recently introduced as a stand-alone, restrictive bariatric surgery. Theoretically, LGS attenuates micronutrients deficiencies and associated complications that were typically observed following malabsorptive procedures. The aim of this study was to assess some micronutrients and mineral deficiencies in patients undergoing LGS. Methods. In the period between July 2008 and April 2010, 138 obese patients (110 females and 28 males) with mean BMI 44.4 kg/m(2) ± 6.5, mean age 43.9 ± 10.9 years were enrolled and underwent LGS. Patients were followed up with routine laboratory tests and anthropometric measurements and assessed for nutritional status, as regards vitamin B12, folic acid, iron, hemoglobin, calcium, and vitamin D, every three months throughout 12 months. Results. 12 months after sleeve, patients did not show iron deficiency and/or anemia; plasma calcium levels were in the normal range without supplementation from the sixth month after the operation. Vitamin B12 and folic acid were adequately supplemented for all the follow-up period. Vitamin D was in suboptimal levels, despite daily multivitamin supplementation. Conclusion. In this study, we showed that LGS is an effective surgery for the management of morbid obesity. An adequate supplementation is important to avoid micronutrients deficiencies and greater weight loss does not require higher dosage of multivitamins.
Journal of obesity 03/2012; 2012:672162. DOI:10.1155/2012/672162
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