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

Laparoscopic Sleeve Gastrectomy, 529 Cases Without a Leak: Short-Term Results and Technical Considerations,10.1007/s11695-010-0320-y,Obesity Surgery,D

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Laparoscopic Sleeve Gastrectomy, 529 Cases Without a Leak: Short-Term Results and Technical Considerations   (Citations: 4)
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Background  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. Methods  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. Results  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. Conclusion  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.
Journal: Obesity Surgery - OBES SURG , vol. 21, no. 2, pp. 146-150, 2011
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    • ...The final complication was either a failure to identify a pathology that was present preoperatively (lower oesophageal sphincter spasm [36]) or a narrowed gastrooesophageal junction post-surgery [37] that fortunately was successfully treated with an endoscopic dilatation...

    Ganesh Ramalingam, et al. Our 1Year Experience in Laparoscopic Sleeve Gastrectomy

    • ...Bellanger et al. (20) begin the section at 3–4 cm from the pylorus, thus decreasing the antral volume while preserving its function...
    • ...The incidence of anastomotic leaks after LSG ranges between 0% and 5.5% for primary surgery and 16–24% in reintervention procedures (3, 20, 22)...
    • ...Bellanger et al. (20) show their series of 529 patients presenting no leaks, without using any reinforcing material after the gastric section except the application of fibrin...
    • ...Bellanger et al. (20) strongly believe in two basic principles for minimizing the rate of leaks: The first and most important is to avoid creating a stenosis at the level of the angular incisure, and the second is to avoid mechanical section too close to the esophagus in the area of the cardia...

    Manuel Ferrer-Márquez, et al. Technical Controversies in Laparoscopic Sleeve Gastrectomy

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