Rapport de consensus sur la sleeve gastrectomie

Background

Laparoscopic sleeve gastrectomy (LSG) is an emerging surgical approach, but 1 that has seen a surge in popularity because of its perceived technical simplicity, feasibility, and good outcomes. An international expert panel was convened in Coral Gables, Florida on March 25 and 26, 2011, with the purpose of providing best practice guidelines through consensus regarding the performance of LSG. The panel comprised 24 centers and represented 11 countries, spanning all major regions of the world and all 6 populated continents, with a collective experience of 12,000 cases. It was thought prudent to hold an expert consensus meeting of some of the surgeons across the globe who have performed the largest volume of cases to discuss and provide consensus on the indications, contraindications, and procedural aspects of LSG. The panel undertook this consensus effort to help the surgical community improve the efficacy, lower the complication rates, and move toward adoption of standardized techniques and measures. The meeting took place at on-site meeting facilities, Biltmore Hotel, Coral Gables, Florida.

Methods

Expert panelists were invited to participate according to their publications, knowledge and experience, and identification as surgeons who had performed 500 cases. The topics for consensus encompassed patient selection, contraindications, surgical technique, and the prevention and management of complications. The responses were calculated and defined as achieving consensus (70% agreement) or no consensus (70% agreement).

Results

Full consensus was obtained for the essential aspects of the indications and contraindications, surgical technique, management, and prevention of complications. Consensus was achieved for 69 key questions.

Conclusion

The present consensus report represents the best practice guidelines for the performance of LSG, with recommendations in the 3 aforementioned areas. This report and its findings support a first effort toward the standardization of techniques and adoption of working recommendations formulated according to expert experience. (Surg Obes Relat Dis 2012 8:8?C19) American Society for Metabolic and Bariatric Surgery.     

La sleeve gastrectomy

Acta Endoscopica - La SG occupe une place croissante en chirurgie bariatrique. Comme pour les autres interventions bariatriques, la collaboration avec les gastro-entérologues permet...     

Abcès profond après sleeve gastrectomie: à propos d’un cas traité par ponction percutanée

The case described here involves a patient who developed a gastric fistula following sleeve gastrectomy, performed after a Lap-Band had failed. The fistula dried up spontaneously and the residual abscess was treated by radioguided needle aspiration.     

Ultrasound melted polymer sleeve for improved primary pedicle screw anchorage: A novel augmentation technique

BackgroundCement augmentation of pedicle screws to prevent screw loosening is associated with significant complications, such as cement leakage or bone necrosis. Therefore, an alternative strategy to improve pedicle screw anchorage has been recently developed: Polymer reinforcement of pedicle screws uses an in situ melted polymer sleeve in order to enhance screw anchorage. This biomechanical study evaluated the effect of polymer-reinforcement by comparing polymer-reinforced pedicle screws to non-augmented as well as cement-augmented screws under cyclic loading.MethodsFor each of the two comparisons (polymer-reinforced vs. non-augmented screws and polymer-reinforced vs. cement-augmented screws), polymer-reinforced screws and control screws were placed into the left and right pedicle of seven vertebrae (mean age: 74.0 (SD 9.3) years) to allow for pairwise left–right comparisons. Each screw was subjected to cyclic cranio-caudal loading with an initial load ranging from −50 N to +50 N and with stepwise increasing compressive loads (5 N every 100 cycles) until screw loosening.FindingsPolymer-reinforced pedicle screws resisted a higher number of load cycles until loosening than the contralateral non-augmented control screws (4300 SD 2018 vs. 2457 SD 1116 load cycles, p = 0.015). Screw anchorage of polymer-reinforced pedicle screws was comparable to that of cement augmented control screws (3857 (SD2085) vs. 4300 (SD1257) load cycles until failure, p = 0.64).InterpretationOur findings indicate that polymer-reinforcement significantly enhances pedicle screw anchorage in low quality bone and that its effect is similar in size than that of cement augmentation.