Laparoscopic Sleeve Gastrectomy, 529 Cases Without a Leak: Short-Term Results and Technical Considerations

St. Elizabeth Hospital, Gonzales, LA 70737, USA.
Obesity Surgery (Impact Factor: 3.75). 02/2011; 21(2):146-50. DOI: 10.1007/s11695-010-0320-y
Source: PubMed


Laparoscopic sleeve gastrectomy (LSG) is gaining acceptance among bariatric surgeons as a viable option for treating morbidly obese patients. We describe results of a single surgeon's experience with LSG in a community practice revealing a low complication rate and describing the surgical technique.
LSG was performed in 529 consecutive patients from December 2006 to March 2010. A technique is described where all operations were performed with attention to avoiding strictures at the incisura angularis and stapling close to the esophagus at the angle of His. No operations performed used buttressing material or over-sewing of the staple line. A retrospective chart review and e-mail survey was conducted to determine the occurrence of complications and weight loss.
Follow-up data was collected on 490 of the 529 (92.6%) patients at 6 weeks. A total complication rate of 3.2% and a 1.7% 30-day readmission rate were observed. No leaks occurred in any of the 529 patients, and one death (0.19%) was observed. The most common complications were nausea and vomiting with dehydration and venous thrombosis. The percentages of excess weight loss were 42.36, 65.92, 66.11, and 64.42 with a follow-up of 71%, 68%, 63%, and 49% at 6 months, 1 year, 2, and 3 years, respectively.
The LSG can be performed in a community practice with a low complication rate. Surgeons performing LSG should strive to minimize the risk of creating strictures at the incisura angularis and stapling near the esophagus at the angle of His.

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    • "However, the many points of controversy regarding the procedure create a range of possibilities without consensus: the size of the bougie used as a calibrator, the distance from the pylorus to the first line of section, the section shape at the gastroesophageal junction, the necessity and options available for reinforcing the staple line, and the routine use of intraoperative seal testing. All of these issues are constantly debated among the most experienced authors [17] [18] [19] [20] [21]. "
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    ABSTRACT: Laparoscopic sleeve gastrectomy (LSG) is gaining popularity worldwide as a definitive bariatric procedure. However, there are still some controversial issues associated with the technique, one of which is the size of the residual antrum. Objectives: The aim of this prospective randomized trial is to study the effect of the size of the residual gastric antrum on the outcome of LSG. Settings: University-affiliated hospital. Between November 2009 and August 2013, 113 morbidly obese patients submitted for LSG were randomized into 2 groups, namely antral preserving-LSG (AP-LSG) and antral resecting-LSG (AR-LSG), depending on the distance from the pylorus at which gastric division begins. In the AP-LSG group, the distance was 6 cm from the pylorus and included 58 patients, whereas the distance was 2 cm in the AR-LSG group and included 55 patients. The follow-up period was at least 12 months. Baseline and 6 and 12 month outcomes were analyzed including assessments of the percent excess weight lost (%EWL), reduction in BMI, morbidity, mortality, reoperations, quality of life, and co-morbidities. Both groups were comparable regarding age, gender, body mass index (BMI), and co-morbidities. There was one 30-day mortality, and there was no significant difference in the complication rate or early reoperations between the 2 groups. Weight loss was significant in both groups at 6 and 12 months. At 12 months, weight loss was greater in the AR-LSG than in the AP-LSG group, but with was no significant difference between the 2 groups at 12 months (%EWL was 64.2% in the AP-LSG group and 67.6% in the AR-LSG group; p>.05). The resolution/improvement of co-morbidities, quality of life outcome and the overall prevalence of co-morbidities were similar. LSG with or without antral preservation produces significant weight loss after surgery. The 2 procedures are equally effective regarding %EWL, morbidity, quality of life, and amelioration of co-morbidities. Copyright © 2015 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
    Surgery for Obesity and Related Diseases 12/2014; DOI:10.1016/j.soard.2014.12.025 · 4.07 Impact Factor
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    • "Laparoscopic sleeve gastrectomy (LSG) is a treatment for obesity that involves removal of the fundus and most of the antrum of the stomach, thereby creating a gastric tube or sleeve that restricts oral intake. Several recent randomized studies [1–5], nonrandomized comparison investigations [6–9], and analyses of registries [10, 11] and large series [12, 13] have found that use of LSG as a stand-alone procedure is safe and effective in achieving weight loss. Postsurgical resolution of comorbid conditions such as type 2 diabetes mellitus (T2DM) and hypertension have also been reported [2, 14–20]. "
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    ABSTRACT: Background Stand-alone laparoscopic sleeve gastrectomy (LSG) has been found to be effective in producing weight loss but few large, one-center LSG series have been reported. Gastric leakage from the staple line is a life-threatening complication of LSG, but there is controversy about whether buttressing the staple line with a reinforcement material will reduce leaks. We describe a single-center, 518-patient series of LSG procedures in which a synthetic buttressing material (GORE® SEAMGUARD® Bioabsorbable Staple Line Reinforcement) was used in the most recently treated patients. Methods We retrospectively reviewed the medical records of all patients who underwent LSG in our unit between September 2007 and December 2011. Patients treated before August 2009 did not receive the staple line reinforcement material (n = 186), whereas all patients treated afterward did (n = 332). Results The percentages of excess weight loss in the 518 patients (mean age, 41 years; 82 % female; mean preoperative body mass index, 44 kg/m2) were 67 % (79 % follow-up rate) at 6 months postoperatively, 81 % (64 %) at 1 year, and 84 % (30 %) at 2 years. Type 2 diabetes resolved in 71 % of patients (91/128). Patients given reinforcement material had baseline characteristics similar to those in the no-reinforcement-material group, but had no postoperative staple line leaks or bleeding. The no-reinforcement group had three leaks (p = 0.045) and one case of bleeding. Conclusions LSG resulted in substantial short-term weight loss. Use of the bioabsorbable staple line reinforcement material may decrease leaks after LSG.
    Obesity Surgery 07/2014; 24(7). DOI:10.1007/s11695-014-1251-9 · 3.75 Impact Factor
    • "The laparoscopic literature has several reports of successful bariatric procedures in patients with situs inversus despite the extremely low prevalence of this condition.[1–3] While several equivalent alternatives are available in the bariatric algorithm, more recently the laparoscopic sleeve gastrectomy (SG) has been gaining traction as an effective means of weight loss in patients with morbid obesity.[4–7] "
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    ABSTRACT: While several equivalent alternatives are available in the bariatric algorithm, more recently the laparoscopic sleeve gastrectomy (SG) has been gaining traction as an effective means of weight loss in patients with morbid obesity. We present the case of a 39-year-old woman with situs inversus totalis, who was taken to the operating room for laparoscopic SG. The patient had previously undergone a failed open gastric banding procedure 20 months earlier. Awareness of the inherited condition before performing the operation allows for advanced planning and preparation. Subsequent modifications to the standard trocar placement help make the procedure more technically feasible. To our knowledge, this is the first published report of a laparoscopic SG after open gastric banding in a patient with situs inversus totalis. After encountering the initial disorientation, we believe experienced laparoscopic surgeons can perform this procedure successfully and safely.
    Journal of Minimal Access Surgery 07/2012; 8(3):93-6. DOI:10.4103/0972-9941.97595 · 0.81 Impact Factor
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