Sleeve urethroplasty: New technique

A single-stage urethroplasty for penile urethral stricture is described. This method obviated some of the common complications, such as fistula formation. This operation was performed on 11 patients with encouraging results. Further study is needed to assess its ultimate value.     

Simultaneous Gastric Band Removal and Sleeve Gastrectomy: a Comparison with Front-Line Sleeve Gastrectomy

The placement of a gastric band (GB) prior to a sleeve gastrectomy (LSG) would increase postoperative complications, whether it is withdrawn or not at the time of the LSG. The purpose of this retrospective study was to evaluate and compare postoperative morbidity and outcome weight for simultaneous GB removal (RGB) and LSG (the RGB?+?LSG group) and front-line LSG only (the LSG group) after unsuccessful GB. From May 2005 to May 2009, 305 patients underwent first- or second-line LSG at Amiens University Hospital. The primary endpoint was the postoperative complication rate (according to the Clavien classification) in the RGB?+?LSG and LSG groups. The secondary endpoints were intra-operative data, postoperative data, and weight loss over a period of 2?years (body mass index, percentage of excess weight loss, and percentage of excess body mass index (BMI) loss). Univariate and multivariate propensity score analyses were used to search for independent risk factors for postoperative complications. The RGB + LSG group (n?=?46) had a mean age of 42 and a mean BMI of 44?kg/m(2). The indication for surgery was renewed weight gain or insufficient weight loss in 68?% of these cases. The LSG group (n?=?259) had a mean age of 41 and a mean BMI of 49.2?kg/m(2). All procedures were performed laparoscopically. The complication rate was 8.6?% in the RGB + LSG group and 8?% in the SG group (p?=?0.42). The fistula rates in the two groups were 4.3 and 3.4?%, respectively (p?=?0.56), and the mean BMI at 2?years was 33.4?kg/m(2) (RGB + LSG group) and 34.4?kg/m(2), respectively (p?=?0.83). The operating time for LSG (after subtracting the time associated with RGB for a combined procedure) averaged 107?min, whereas the operating time for front-line LSG was 89?min (p?=?0.011). The propensity score analysis failed to find independent risk factors for postoperative complications. The performance of RGB + LSG is feasible and does not increase the postoperative morbidity rate. Weight loss after RGB + LSG validates the concept of "restrictive surgery after restrictive surgery". We did not find any independent risk factors that would have justified the avoidance of RGB + SG.     

Sleeve pneumonectomy

Throughout the last year significant advances in the operative technique and management of patients undergoing sleeve pneumonectomy, as well as better understanding of patient selection requirements, have led to improved perioperative and long-term results. Patients with N2 disease resistant to preoperative chemotherapy or chemo-/radiotherapy should be excluded from the procedure. Airway resection should be limited to a maximum length of 4 cm. In general sleeve pneumonectomy has become an established procedure for treatment of lung cancer involving the carina and should be performed for carefully selected patients in experienced centers only.     

Sleeve pneumonectomy

Lung cancer involving the carina can be treated by surgery, but patients must be carefully selected before the operation. Because pneumonectomy is required in addition to carinal resection, patients must be able to withstand the procedure, and they must be told that the operative mortality is 2 to 4 times higher than what is expected after standard pneumonectomy. Patients who have mediastinal nodal disease documented preoperatively by mediastinoscopy should not have this operation. In general, it is possible to perform a safe operation if the surgeon adheres to the principles of healthy bronchial suturing and restricts airway resection to a maximum distance of 4 cm. Surgeons must always remember, however, that it is better and safer to accept a positive resection margin than to have to deal with a bronchopleural fistula caused by anastomotic separation. Finally, reported long-term survival rates of 25% to 40% justify the use of this procedure.     

Sleeve gastrectomy

Sleeve gastrectomy (SG) was originally performed as the restrictive component of the duodenal switch procedure. This partial vertical gastrectomy served to reduce gastric capacity and initiate short-term weight loss while the malabsorptive component of the operation (biliopancreatic diversion) provided the long-term weight loss. Some patients, however, could not undergo the intestinal bypass, and early investigations found that substantial weight loss occurred with the SG alone. The sleeve then developed into a risk management strategy for very large or high-risk patients who would not tolerate a longer or higher-risk procedure.     

Robotic Sleeve Gastrectomy Versus Laparoscopic Sleeve Gastrectomy: a Comparative Study with 200 Patients

The da Vinci Surgical System^® has shown its possible indications in obesity surgery. This clinical study aims to elucidate the benefits, potentials, or problems of applying robotic technology for sleeve gastrectomy (SG). Data from 200 patients who underwent SG either performed by laparoscopy or robotic approach were assessed. A review of the data was analyzed with 1-year follow-up. There were 143 female patients. Mean age was 43.6 years. Mean BMI was 48.4 kg/m². Operative time was longer for the robotic SG group (p?<?0.005). The overall leak rate was 3.5 %. Robotic SG is feasible and may be an initial procedure to undergo more complex procedures. Cost issues and operative times will need to be more clearly estimated in the future.     

Repeat Sleeve Gastrectomy Compared with Primary Sleeve Gastrectomy: A Single-Center, Matched Case Study

Longitudinal sleeve gastrectomy (LSG) has been validated for the treatment of morbid obesity. However, treatment failures can appear several months after SG. Additional malabsorptive surgery is generally recommended in such cases. The objective of the present study was to evaluate the outcomes of repeat SG (re-SG) relative to first-line SG. This was a retrospective study included 15 patients underwent re-SG after failure of first-line SG (i.e. University Hospital, France; Public Practice). These patients were matched (for age, gender, body mass index and comorbidities) 1:2 with 30 patients having undergone first-line SG. The efficacy criteria comprised intra-operative data and postoperative data. The overall study population comprised 45 patients. The re-SG and first-line SG groups did not differ significantly in terms of median age (p?=?NS). The median BMI was similar in the two groups (43?kg/m² vs. 42.3?kg/m², p?=?NS). The two groups were similar in terms of the prevalence of comorbidities. The mean operating time was longer in the re-SG group (116 vs. 86?min; p????0.01). The postoperative complication rate was twice as high in the re-SG group (p?=?0.31). Two patients in the re-SG group developed a gastric fistula (p?=?0.25) and one of the latter died. At 12?months, the Excess Weight Loss was 66?% (re-SG group) and 77?% (first-line SG group) (p?=?0.05). Re-SG is feasible but appears to be associated with a greater risk of complications. Nevertheless, re-SG can produce results (in terms of weight loss), equivalent to those obtained after first-line SG.     

Deciphering the Sleeve: Technique,Indications, Efficacy,and Safety of Sleeve Gastrectomy

Some institutions perform sleeve gastrectomy (SG) as the initial operation for high-risk, high body mass index patients planning a definitive weight loss operation in 12–18 months. Other institutions consider SG a viable alternative to other bariatric operations. SG is frequently debated among the bariatric surgeons. Many questions remain about the current state of SG. Should it be performed as a definitive weight loss procedure or as a bridge for another bariatric procedure? Is there a specific BMI at which point SG should be encouraged? Is the weight loss comparable to other bariatric procedures? Is there a higher risk of gastric leak? What is the appropriate sleeve size? What are the hormonal benefits? Does SG predispose to gastroesophageal reflux disease? What is the mechanism of weight loss? Are long-term results available? And what are the complications? We conducted an extensive literature review aiming to resolve these commonly asked questions.     

Sleeve gastrectomy: radiologic patterns after surgery

Background  Laparoscopic sleeve gastrectomy (LSG) is gaining popularity as an additional bariatric procedure, either as a first step for biliopancreatic diversion or gastric bypass or as a stand-alone option for selected patients. Early postoperative fluid tolerance varies between patients and influences the length of hospital stay. Swallow studies after LSG are not uniform and display different patterns with regard to contrast passage through the gastric sleeve. Methods  The 55 patients (40 women) in this study underwent LSG during 18 months. These patients had a mean age of 38.2 years (range: 17–61 years) and a mean body mass index (BMI) of 44.8 kg/m² (range: 39–75 kg/m²). The LSG procedure was performed using a four-port technique to resect the greater curvature of the stomach around a bougie. The mean operative time was 120 min (range: 45–240 min). A routine swallow study was performed on postoperative day 1, and clear fluids were initiated if no leak was detected. Patients were discharged when they could tolerate a daily fluid intake of 2 l. Results  No mortalities, obstructions, or leaks occurred in the study cohort. Two main patterns of contrast passage were identified: type 1 (immediate unhindered flow through the sleeve to the antrum with a slight delay before continuation of the contrast to the duodenum) and type 2 (contrast filling of the proximal sleeve with delay of flow distally toward the duodenum). Patients with rapid contrast passage (group 1, n = 24) tolerated clear fluids better than those with delayed flow (group 2, n = 31) and were discharged earlier than their counterparts (mean length of hospital stay, 2.5 vs. 3.4 days; p < 0.001). Conclusions  Tolerance of fluid intake after LSG is crucial for patient recovery and discharge. A distinct radiologic appearance on postoperative day 1 helps to predict this behavior. The different patterns could be related to gastric sleeve construction or to possible postoperative sleeve spasm, hindering fluid passage. The influence of immediate fluid tolerance on weight loss after LSG is currently under investigation. Presented at the 16th Annual European Association for Endoscopic Surgery (EAES) Conference, Stockholm, Sweden, 11–14 June 2008.     

Sleeve plus procedures: need of time

Laparoscopic sleeve gastrectomy as a standalone procedure has gained a lot of popularity over laparoscopic Roux-en-Y gastric bypass in the last decades and is the most frequently performed bariatric procedure worldwide; however, the long-term results are not promising in terms of weight regain and re-emergence of comorbidities. Considering the proven concept of biliopancreatic diversion with duodenal switch, many novel procedures have been developed involving a sleeve gastrectomy along with some intestinal bypass or alteration in small intestine anatomy. These procedures show better technical feasibility and are associated with less post-operative morbidity, sleeve plus procedures permanently adopt the digestive tract to the present lifestyle, by eliminating the gastric storage of hypercaloric and excessively processed food, and providing the ileum with the needed stimulus for incretin release.     

Transumbilical Sleeve Gastrectomy

Laparoscopic sleeve gastrectomy is a procedure for the management of morbid obesity, which usually implies the placement of multiple trocars. It is now possible to perform procedures through smaller incisions, known as “invisible” or single port surgery. We describe the case of a transumbilical sleeve gastrectomy completed totally laparoscopically through a single port using a multichannel device.     

腹腔镜袖状胃切除术

患者女性，30岁，BMI36.6，诊断代谢综合征。患者平卧"大"字位，头高左侧高30°，主刀右侧站位。距幽门2 cm开始紧贴胃壁游离胃大弯，充分游离胃底，显露左侧膈肌脚及食道左侧，经口置入36 F减重胃管，沿胃管距幽门4 cm开始进行袖状胃裁剪，根据胃壁厚度应用不同钉脚高度的切割闭合钉，连续全层缝合加固胃切缘，并将胃切缘复位固定于大网膜及胰腺背膜，经主操作孔取出切除的胃组织，清理腹腔，放置引流管，缝合戳卡孔。     

Laparoscopic Sleeve Gastrectomy: A Multi-purpose Bariatric Operation

Background: The use of the laparoscopic sleeve gastrectomy (LSG), a restrictive operation, in different settings, is presented. Methods: 31 patients underwent LSG in the following groups: 1) 7 patients with very high BMI as a first stage of the duodenal switch (DS); 2) 7 morbidly obese patients with severe medical conditions; 3) 16 obese patients with lower BMI (35-43); and 4) 1 patient converted from a prior gastric banding. Results: 1 patient with BMI 74 died, a 3.2% mortality. The percentage of excess BMI loss (%EBMIL) in group 1 above was 63.1% from 4-27 months. The %EBMIL of the cirrhotics in group 2 was 76.0% (69-100%). The %EBMIL in group 3 patients was 68.5% (58.3-123%) at 3-27 months. The %EBMIL of the group 4 patient is 13% because she had previously lost almost all of her EBMI. Conclusion: LSG may become the ideal operation for staging in patients with BMI >55, for treating morbidly obese patients with severe medical conditions, as an excellent alternative to adjustable bands in lower BMI patients, or for conversion of gastric banding patients.