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1.
A Prospective Randomized Study Comparing Two Different Techniques for Laparoscopic Sleeve Gastrectomy 总被引:1,自引:1,他引:0
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) represents a relatively new restrictive operation for obesity. We report a prospective randomized study comparing two different techniques of performing this procedure. METHODS: Between January and August 2006, 20 patients (group A) and 20 patients (group B) were prospectively and randomly submitted to LSG. The characteristics of the patients in the two groups were similar for age and sex. The median preoperative weight was of 120 kg (95-180) (A) and 133 kg (83-175) (B) (NS). The median preoperative BMI was of 42.5 kg/m2 (35-58) (A) and 47 kg/m2 (37-58) (B) (NS). The two techniques differ in that in A, stapling is performed after full devascularization and mobilization of the gastric curve, whereas in B stapling is performed as soon as the lesser sac is entered and the greater curve is devascularized after full completion of the sleeve. The staple-line is reinforced at the end of stapling in both techniques. RESULTS: Median operative time was 34 min (12-54) (A) and 25 min (9-51) (B) (P = 0.06). Median peroperative bleeding was 5 mL (0-450) (A) and 5 mL (0-100) (B) (P = 0.37). Median number of staple cartridges used was 6 (5-7) (A) and 6 (4-7) (B) (P = 0.63). Peroperative complications were a small hiatal hernia requiring repair and a bleeding in two patients of A. Postoperative leak occurred in 1 patient of A, and minor early complications affected 2 patients of A and 1 patient of B. Peroperative and postoperative mortality was 0. Median hospital stay was 3 days (1-10) (A) and 3 days (2-7) (B) (P = 0.59). One stenosis as a late complication appeared in a patient of B. %EWL at 6 months and 1 year was respectively 43.4% (A), 42.2% (B) and 48.3% (A) 49.5% (B) (P = 0.82). CONCLUSION: LSG can be performed by two different techniques. The technique B (section of the stomach followed by its mobilization) appears familiar to surgeons usually performing laparoscopic RYGBP. No observed differences are significant, but the technique B when looking at observed distributions, seems to be better than the technique A (mobilization of the stomach followed by its section) in terms of operative time, peroperative bleeding and hospital stay. 相似文献
2.
Background
Gastric leak and hemorrhage are the most important challenges after laparoscopic sleeve gastrectomy (LSG). In order to reduce these complications, the staple line can be reinforced by absorbable sutures or by the use of glycolide trimethylene carbonate copolymer onto the linear stapler (Gore Seamguard®; W.L. Gore &; Associates, Inc, Flagstaff, AZ). To our knowledge, there are no randomized studies showing the utility of staple line reinforcement during LSG. The purpose of this study was to randomly compare three techniques in LSG: no staple line reinforcement (group 1), buttressing of the staple line with Gore Seamguard® (group 2), and staple line suturing (group 3).Methods
Between January 2008 and February 2009, 75 patients were prospectively and randomly enrolled in the three different techniques of handling the staple line during LSG. The patient groups were similar (NS).Results
Mean operative time to perform the stomach sectioning was 15.9?±?5.9 min (group 1), 20.8?±?8.1 min (group 2), and 30.8?±?10.1 min (group 3) (p?0.001). Mean total operative time was 47.4?±?10.7 min (group 1), 48.9?±?18.4 min (group 2), and 59.9?±?19.6 min (group 3) (p?=?0.02). Mean blood loss during stomach sectioning was 19.5?±?21.3 mL (group 1), 3.6?±?4.7 mL (group 2), and 16.7?±?23.5 mL (group 3) (p?0.001). Mean total blood loss was 48.9?±?67.1 mL (group 1), 32.5?±?46.5 mL (group 2), and 61.9?±?69.4 mL (group 3) (p?=?0.03). Mean number of stapler cartridges used was 5.6?±?0.7 (group 1), 5.7?±?0.7 (group 2), and 5.8?±?0.6 (group 3) (NS). Postoperative leak affected one patient (group 1), two patients (group 2), and one patient (group 3) (NS). Mean hospital stay was 3.6?±?1.4 days (group 1), 3.9?±?1.5 days (group 2), and 2.8?±?0.8 days (group 3) (p?=?0.01).Conclusions
In LSG, buttressing the staple line with Gore Seamguard® statistically reduces blood loss during stomach sectioning as well as overall blood loss. No staple line reinforcement statistically decreases the time to perform stomach sectioning and the total operative time. No significant difference is evidenced in terms of postoperative leak between the three techniques of LSG.3.
4.
Albanopoulos K Alevizos L Flessas J Menenakos E Stamou KM Papailiou J Natoudi M Zografos G Leandros E 《Obesity surgery》2012,22(1):42-46
Background
Sleeve gastrectomy involves the creation of small gastric reservoir based on lesser curvature of the stomach, which is fashioned by a longitudinal gastrectomy that preserves the antrum and pylorus together with its vagal innervation. The main complications in the early postoperative course are bleeding and gastric leak. In order to reduce these complications the staple line can be reinforced in many different ways. The purpose of this study was to randomly compare two different techniques in laparoscopic sleeve gastrectomy (LSG): buttressing the staple line at the gastroesophageal junction (angle of Hiss) with Gore Seamguard and staple-line suturing with PDS 2.0. 相似文献5.
《The Surgical clinics of North America》2021,101(2):177-188
6.
Lindsay B. Adams Craig Chang Janet Pope Yeonsoo Kim Pei Liu Amy Yates 《Obesity surgery》2016,26(5):990-994
Background
Several studies have examined the role of ursodeoxycholic acid (UDCA) for the prevention of cholelithiasis (gallstones) following rapid weight loss from restrictive diets, vertical band gastroplasty, and Roux-en-Y gastric bypass. However, to date, there have been no prospective, controlled studies examining the role of UDCA for the prevention of gallstones following sleeve gastrectomy (SG). This study was conducted to identify the effectiveness of UDCA for prevention of gallstones after SG.Methods
Following SG, eligible patients were randomized to a control group who did not receive UDCA treatment or to a group who were prescribed 300 mg UDCA twice daily for 6 months. Gallbladder ultrasounds were performed preoperatively and at 6 and 12 months postoperatively. Patients with positive findings preoperatively were excluded from the study. Compliance with UDCA was assessed.Results
Between December 2011 and April 2013, 37 patients were randomized to the UDCA treatment arm and 38 patients were randomized to no treatment. At baseline, the two groups were similar. At 6 months, the UDCA group had a statistically significant lower incidence of gallstones (p?=?0.032). Analysis revealed no significant difference in gallstones between the two groups at 1 year (p?=?0.553 and p?=?0.962, respectively). The overall gallstone formation rate was 29.8 %.Conclusions
The incidence of gallstones is higher than previously estimated in SG patients. UDCA significantly lowers the gallstone formation rate at 6 months postoperatively.7.
Prospective Randomized Comparison of Linear Staplers during Laparoscopic Roux-en-Y Gastric Bypass 总被引:3,自引:0,他引:3
Background: The development of laparoscopic linear staplers has enabled minimally invasive approaches to bariatric surgery,
but there have been no comparison studies of the two current 6-row devices. We report our experience with a prospective randomized
comparison of 6-row linear staplers during laparoscopic Roux-en-Y gastric bypass (LRYGBP). Methods: From January to March
2003, 100 patients were randomly assigned to undergo LRYGBP with either an Endo-GIA Universal 6-row stapler (USSC) or the
ETS-Flex 6-row stapler (Ethicon). Mean preoperative BMI was 49±8 for 50 Endo-GIA patients, and 49±7 for 50 ETS-Flex patients.
Parameters measured included quantity of cartridges, handles, hemoclips, estimated blood loss, misfires, OR time, postoperative
leaks and bleeds, and cost. Results: Mean follow-up was 135 days (range 90- 180). The ETS-Flex group experienced significantly
more misfires (28% vs 2%, P <.001), hemoclips applied (30±9 vs 21±7, P <.001), estimated blood loss (132±56 vs 100±32 ml, P <.001) and OR time (66±19 vs 58±13 mins, P <.02) compared with the Endo-GIA group respectively.There was one postoperative leak associated with the ETS-Flex group and
two postoperative bleeds with the Endo-GIA group, which were not a significant differences.The Endo-GIA group averaged $319
more per case for staple cost. Conclusion: While the ETS-Flex stapler was less expensive, it was associated with more technical
failures requiring surgeon intervention to reduce potential patient morbidity, compared with the Endo-GIA. 相似文献
8.
A Prospective Randomized Study Between Laparoscopic Gastric Banding and Laparoscopic Isolated Sleeve Gastrectomy: Results after 1 and 3 Years 总被引:6,自引:1,他引:5
Background: Laparoscopic adjustable gastric banding (GB) is the most popular restrictive procedure for obesity in Europe.
Isolated sleeve gastrectomy (SG), is less common, but more invasive and with a higher learning curve. The aim of this prospective
randomized study was to compare the results of GB and SG after 1 and 3 years of surgery. Methods: 80 patient candidates for
laparoscopic restrictive surgery were operated consecutively and randomly, between January and December 31, 2002, by GB (7M,
33F) or by SG (9M, 31F) (NS). Median age was 36 (20-61) for GB versus 40 (22-65) for SG (NS). Median BMI was 37 (30-47) for
GB versus 39 (30-53) for SG (NS). After 1 and 3 years: weight loss, feeling of hunger, sweet eating, gastroesophageal reflux
disease (GERD), complications and re-operations were recorded in both groups. Results: Median weight loss after 1 year was
14 kg (−5 to +38) for GB and 26 kg (0 to 46) for SG (P<0.0001); and after 3 years was 17 kg (0 to 40) for GB and 29.5 kg (1 to 48) for SG (P<0.0001). Median decrease in BMI after 1 year was 15.5 kg/m 2 (5 to 39) after GB and 25 kg/m2 (0 to 45) after SG (P<0.0001); and after 3 years was 18 kg/m2 (0 to 39) after GB and 27.5 kg/m 2 (0 to 48) after SG (P=0.0004). Median %EWL at 1 year was 41.4% (−11.8 to +130.5) after GB and 57.7% (0 to 125.5) after SG (P=0.0004); and at 3 years was 48% (0 to 124.8) after GB and 66% (−3.1 to +152.4) after SG (P=0.0025). Loss of feeling of hunger after 1 year was registered in 42.5% of patients with GB and in 75% of patients with SG
(P=0.003); and after 3 years in 2.9% of patients with GB and 46.7% of patients with SG (P<0.0001). Loss of craving for sweets after 1 year was achieved in 35% of patients with GB and 50% of patients with SG (NS);
and after 3 years in 2.9% of patients with GB and 23% of patients with SG (NS). GERD appeared de novo after 1 year in 8.8% of patients with GB and 21.8% of patients with SG (NS); and after 3 years in 20.5% of patients with
GB and 3.1% of patients with SG (NS). Postoperative complications requiring re-operation were necessary for 2 patients after
SG. Late complications requiring re-operation after GB included 3 pouch dilations treated by band removal in 2 and 1 laparoscopic
conversion to Roux-en-Y gastric bypass (RYGBP), 1 gastric erosion treated by conversion to RYGBP, and 3 disconnections of
the system treated by reconnection. Inefficacy affected 2 patients after GB, treated by conversion into RYGBP and 2 patients
after SG treated by conversion to duodenal switch. Conclusion: Weight loss and loss of feeling of hunger after 1 year and
3 years are better after SG than GB. GERD is more frequent at 1 year after SG and at 3 years after GB. The number of re-operations
is important in both groups, but the severity of complications appears higher in SG. 相似文献
9.
Aiolfi Alberto Gagner Michel Zappa Marco Antonio Lastraioli Caterina Lombardo Francesca Panizzo Valerio Bonitta Gianluca Cavalli Marta Campanelli Giampiero Bona Davide 《Obesity surgery》2022,32(5):1466-1478
Obesity Surgery - Staple line reinforcement (SLR) during laparoscopic sleeve gastrectomy (LSG) is controversial. The purpose of this study was to perform a comprehensive evaluation of the most... 相似文献
10.
Peterli R Steinert RE Woelnerhanssen B Peters T Christoffel-Courtin C Gass M Kern B von Fluee M Beglinger C 《Obesity surgery》2012,22(5):740-748
Background
The mechanisms of amelioration of glycemic control early after laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) are not fully understood. 相似文献11.
Amani Jambhekar Amy Maselli Ryan Lindborg Krystyna Kabata Anthony Tortolani Piotr Gorecki 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2016,20(3)
Methods:Data on 343 consecutive LSG operations performed from February 2010 to May 2014 by a single surgeon (PG) were analyzed. Patients readmitted within 30 d were compared to the remaining patients by using Student''s t test for continuous variables and the χ2 test for categorical variables.Results:All LSGs were completed laparoscopically with no conversions to open procedures. There were no reoperations, leaks, perioperative hemorrhages, or mortalities. Twelve patients (3.5%) were readmitted; 1 was readmitted twice. There were no identified risk factors for readmission, including patient demographics, comorbidities, and perioperative factors. Notably, 7 (7%) readmissions occurred in the initial 100 patients and 5 (2%) in the remaining 243 patients (P = .04). Clinical pathways were modified after the initial 100 patients; routine contrast esophagograms were no longer performed, and a 1-day routine postoperative stay was adopted. Operative time also decreased from 94.2 ± 23.8 to 78.2 ± 20.0 min (P < .001).Conclusions:Readmission rates after LSG remain in a range similar to those described for other laparoscopic bariatric procedures. Larger prospective studies are needed to identify patterns of complications and readmissions in patients undergoing LSG that may differ from other bariatric procedures. 相似文献
12.
Early Weight Recidivism Following Laparoscopic Sleeve Gastrectomy: A Prospective Observational Study
Mohamed H. A. Fahmy Mohamed D. Sarhan Ayman M. A. Osman Ahmad Badran Amr Ayad Dalia K. Serour Hany A. Balamoun Mohamed E. Salim 《Obesity surgery》2016,26(11):2654-2660
Background
Although weight loss following laparoscopic sleeve gastrectomy (LSG) can be substantial, weight recidivism is still a major concern. The aim of our work is to study early weight recidivism following LSG and to evaluate the role of gastric computed tomography volumetry (GCTV) in the assessment of patients experiencing early weight regain.Methods
One-hundred and one morbidly obese patients undergoing LSG were prospectively studied. Patients were followed up for 2 years. Those who presented with weight recidivism were counseled for dietary habits and assessed for the amount of weight regain. Patients who regained weight were scheduled for GCTV.Results
Twelve patients were excluded from the study. Weight recidivism was reported in 9/89 patients (10.1 %) [weight loss failure (n?=?1), weight regain (n?=?8)] and was almost always first recognized 1½–2 years after LSG. The amount of weight regain showed negative correlations with preoperative body weight and body mass index (r?=??0.643, P?=?0.086 and r?=??0.690, P?=?0.058; respectively) and positive correlations with the distance between the pylorus and the beginning of the staple line (r?=?0.869, P?=?0.005), as well as with the residual gastric volume (RGV) on GCTV 2 years after LSG (r?=?0.786, P?=?0.021).Conclusions
In the small group of patients who regained weight, a longer distance between the pylorus and the beginning of the staple line, as well as a higher RGV on GCTV 2 years after LSG, were both associated with increased weight regain. Gastric computed tomography volumetry with RGV measurement holds promise as a useful research tool after LSG.13.
Manuel Ferrer Márquez Manuel Ferrer Ayza Ricardo Belda Lozano María del Mar Rico Morales Jose Miguel García Díez Ricardo Belda Poujoulet 《Obesity surgery》2010,20(9):1306-1311
Sleeve gastrectomy is a recently developed technique for treating morbid obesity. Since it is a simple procedure, the number
of surgeons using it has grown in recent years. The patients who present fistulas after surgery often undergo a harrowing
postoperative period as well as increased morbidity and mortality. Our aim was to assess the incidence, causes, diagnosis,
management, and prevention of leaks after sleeve gastrectomy. 相似文献
14.
15.
16.
Laparoscopic sleeve gastrectomy is a recently developed technique for treating morbid obesity. Since it is a simple procedure,
many bariatric surgeons have adopted it in recent years with good results. However, there is still no standard procedure across
different surgical teams. We will discuss the more controversial aspects of the surgical technique: the size of the bougie,
the beginning of the distal section, the section shape at the gastroesophageal junction, the necessity and manner of reinforcing
the staple line, and the routine use of intraoperative leak testing. 相似文献
17.
Tamer Youssef Emad Abdalla Khalid El-Alfy Ibrahim Dawoud Mosaad Morshed Mohamed Farid 《Obesity surgery》2016,26(3):494-504
Background
The most frequent and most feared complication after laparoscopic sleeve gastrectomy (LSG) is gastric leak (GL). We hypothesize that botulinum neurotoxin (botulinum type A (BTX-A)) injection into the pyloric sphincter muscle at the time of operation may decrease the risk of postoperative GL.Methods
Consecutive patients with morbid obesity (MO) treated by LSG were enrolled. Patients were randomly allocated into two groups: group I (intrapyloric BTX-A injection was performed) and group II (no injection was performed). The primary outcome measure was number of patients developing GL. Secondary outcome measures were percent of excess weight loss, postoperative complications, and their management.Results
One hundred and fifteen patients (86 (74.8 %) females) were randomized into two groups of 57 patients (group I) and 58 patients (group II). Four patients in group II developed GL versus no patient in group I (P?=?0.04). Ten patients in group I and two in group II developed refractory epigastric pain (P?=?0.01). Other complication rates were comparable for both groups. Mean preoperative BMI of patients in both groups had significantly decreased from 54.64?±?6.82 to 42.99?±?5.3 at 6 months and to 39.09?±?5.14 at 12 months (P?<?0.001).Conclusions
LSG is an effective, safe, and minimally invasive procedure for treatment of MO. No patient in whom pyloric BTX-A injection was performed developed postoperative GL versus four patients in whom injection was not performed. The difference in GL rate was statistically significant, thus favoring the use of pyloric BTX-A injection during LSG.18.
Tiago Rafael Onzi Armando José d’Acampora Fabricio Miri de Araújo Ricardo Baratieri Gilberto Kremer Humberto Fenner Lyra Jr. Joyce Tarnowsky Leitão 《Obesity surgery》2014,24(3):371-376
Background
Sleeve gastrectomy (SG) produces excellent results in weight reduction and resolution of comorbidities. The histology of the gastric mucosa can be affected by the surgical procedure, with alterations of inflammatory patterns. The objective of this study is to evaluate alterations of the inflammatory patterns of the gastric mucosa in SG and the results in weight loss and resolution of comorbidities.Methods
Morbidly obese patients were selected to undergo SG. Endoscopies were performed pre-operatively and post-operatively after 6 months, with an incisura and 3 cm before the pylorus biopsies. Data on weight, height, and associated diseases were collected. The data were compared, and the biopsies evaluate the inflammatory patterns.Results
There was a reduction of body weight with a pre-operative weight of 132.5?±?15.7 kg and a post-operative weight of 95.8 ±10.6 kg with a p?<?0.001. Also, the body mass index (BMI) was reduced significantly with a mean pre-operative of 42.6?±?10.6 kg/m2 and a post-operative of 30.9?±?3.2 kg/m2 with a p?<?0.001. The comorbidities were all resolved or improved. The pattern of gastric histology showed chronic gastritis with inflammatory activity associated with Helicobacter pylori in 33.3 % of the patients, along with foveolar hyperplasia at 58.3 %. The chronic gastritis with discrete inflammatory activity was reduced by 16.7 %, and the foveolar hyperplasia was reduced by 33.3 %.Conclusion
The inflammatory alterations in the pre-operative period were mainly foveolar hyperplasia and chronic gastritis associated with H. pylori, and they were reduced in the post-operative period. A significant reduction of weight and BMI occurred, and a resolution of comorbidities was observed. 相似文献19.
Background
Laparoscopic sleeve gastrectomy (LSG) has become a common option in the management of morbid obesity. Although this procedure seems easier, many caveats remain, especially in terms of leakage. Other serious complications include strictures, bleeding, and gastroesophageal reflux disease (GERD). Strictures are related to operative technique but also to healed leaks and fistulas. To our knowledge, the literature reports on the physiopathology and management of strictures after LSG are scarce.Methods
A retrospective analysis of our database provided a total of 16 patients who underwent laparoscopic surgery for the treatment of strictures. A comprehensive review of each case was done including their management.Results
Sixteen patients were treated laparoscopically for strictures. There were eight females (mean age, 40.6 years). Most common complaints were dysphagia (n?=?14) and/or GERD (n?=?8). Body Mass Index was 30.5 kg/m2?±?9.3. Fourteen patients underwent a seromyotomy (SM) and two a wedge resection of the stenosis. After SM, morbidity included five leaks on the short term and five reoperations in the long-term. Of the 16 patients, 12 were treated satisfactorily, three required endoscopies and one had minimal GERD symptoms.Conclusions
Strictures and stenosis can be managed by laparoscopic approach with acceptable results. SM can be useful but carries a high complication rate. Accurate technique with parsimonious use of coagulation and possibly with the systematic use of an omental patch might lead to better results. The wedge resection of the stomach including the stricture was performed successfully in two cases. In addition, wedge resection was used secondarily in two other cases to address a complication of the seromyotomy. 相似文献20.
Bariatric surgery is recommended for Indian patients with body mass index (BMI) >32.5 kg/m2 with at least one comorbidity and >37.5 kg/m2 without a comorbidity. In laparoscopic sleeve gastrectomy, bleeding and leakage from the staple line are common post-operative events. Peri-Strips Dry® with Veritas® (PSD-V) is used in staple-line reinforcement. This was a single-investigator, multicenter, randomized study of 100 patients undergoing standard sleeve gastrectomy with a 34 or 36 French bougie. Patients were randomized 1:1 to PSD-V or control groups; no buttress material was used in the control group. The primary objective was to assess complication rates (any staple-line bleed or leak from the intra-operative visit through day 30) associated with sleeve gastrectomy. Surgical time (from first incision to closure of last incision) and the number of clips and/or sutures used to control bleeding were also assessed. Fewer staple-line bleeds were observed in the PSD-V group than the control group (23/51 [45.1 %] vs 39/49 [79.6 %] patients; p?=?0.0005), and the bleeding was of a lower severity (p?=?0.0002). No staple-line leaks were observed. Surgical time was shorter in patients who received PSD-V (58.8 vs 72.8 min; p?=?0.0153), and fewer patients required hemostatic clips and/or sutures (10/51 [19.6 %] vs 33/49 [67.3 %] patients; p?0.0001). Fewer patients in the PSD-V than the control group experienced adverse events (2/51 [3.9 %] vs 5/49 [10.2 %] patients). The use of PSD-V reduced the incidence and severity of staple-line bleeding and was associated with a reduction in surgical time compared with no staple-line reinforcement. 相似文献