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Technical Controversies in Laparoscopic Sleeve Gastrectomy

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Abstract

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.

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References

  1. Serra C, Pérez N, Bou R, et al. Laparoscopic sleeve gastrectomy. A bariatric procedure with multiple indications. Cir Esp. 2006;79(5):289–92.

    Article  PubMed  Google Scholar 

  2. Marceau P, Cabanac M, Frankham PC, et al. Accelerated satiation after duodenal switch. Surg Obes Relat Dis. 2005;1(4):408–12.

    Article  PubMed  Google Scholar 

  3. Márquez MF, Ayza MF, Lozano RB, et al. Gastric leak after laparoscopic sleeve gastrectomy. Obes Surg. 2010;20(9):1306–11.

    Article  PubMed  Google Scholar 

  4. Almogy G, Crookes PF, Anthone GJ. Longitudinal gastrectomy as a treatment for the high-risk super-obese patient. Obes Surg. 2004;14(4):492–7.

    Article  PubMed  Google Scholar 

  5. Gagner M, Patterson E. Laparoscopic biliopancreatic diversion with duodenal switch. Dig Surg. 2000;17:547–66.

    Article  Google Scholar 

  6. Regan JP, Inabnet WB, Gagner M. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg. 2003;13:861–4.

    Article  PubMed  CAS  Google Scholar 

  7. Akkary E, Duffy A, Bell R. Deciphering the sleeve: technique, efficacy, and safety of sleeve gastrectomy. Obes Surg. 2008;18:1323–9.

    Article  PubMed  Google Scholar 

  8. Buchwald H, Oien DM. Metabolic/bariatric surgery Worldwide 2008. Obes Surg. 2009;19(12):1605–11.

    Article  PubMed  Google Scholar 

  9. Yehoshua RT, Eidelman LA, Stein M, et al. Laparoscopic sleeve gastrectomy—volume and pressure assessment. Obes Surg. 2008;18:1083–8.

    Article  PubMed  Google Scholar 

  10. Gagner M. Leaks after sleeve gastrectomy are associated with smaller bougies: prevention and treatment strategies. Surg Laparosc Endosc Percutan Tech. 2010;20(3):166–9.

    Article  PubMed  Google Scholar 

  11. Roa PE, Kaidar-Person O, Pinto D, et al. Laparoscopic sleeve gastrectomy as treatment for morbid obesity: technique and short-term outcome. Obes Surg. 2006;16(10):1323–6.

    Article  PubMed  Google Scholar 

  12. Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis. 2009;5(4):469–75.

    Article  PubMed  Google Scholar 

  13. Weiner RA, Weiner S, Pomhoff I, et al. Laparoscopic sleeve gastrectomy—influence of sleeve size and resected gastric volume. Obes Surg. 2007;17(10):1297–305.

    Article  PubMed  Google Scholar 

  14. Parikh M, Gagner M, Heacock L, et al. Laparoscopic sleeve gastrectomy: does bougie size affect mean %EWL? Short-term outcomes. Surg Obes Relat Dis. 2008;4(4):528–33.

    Article  PubMed  Google Scholar 

  15. Mognol P, Chosidow D, Marmuse JP. Laparoscopic sleeve gastrectomy as an initial bariatric operation for high-risk patients: initial results in 10 patients. Obes Surg. 2005;15(7):1030–3.

    Article  PubMed  Google Scholar 

  16. Baltasar A, Serra C, Pérez N, et al. Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obes Surg. 2005;15(8):1124–8.

    Article  PubMed  Google Scholar 

  17. Givon-Madhala O, Spector R, Wasserberg N, et al. Technical aspects of laparoscopic sleeve gastrectomy in 25 morbidly obese patients. Obes Surg. 2007;17(6):722–7.

    Article  PubMed  Google Scholar 

  18. Silecchia G, Boru C, Pecchia A, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obes Surg. 2006;16(9):1138–44.

    Article  PubMed  Google Scholar 

  19. Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc. 2006;20(6):859–63.

    Article  PubMed  CAS  Google Scholar 

  20. Bellanger DE, Greenway FL. Laparoscopic sleeve gastrectomy, 529 cases without a leak: short-term results and technical considerations. Obes Surg. 2011;21(2):146–50.

    Article  PubMed  Google Scholar 

  21. Sánchez-Santos R, Masdevall C, Baltasar A, et al. Short- and mid-term outcomes of sleeve gastrectomy for morbid obesity: the experience of the Spanish National Registry. Obes Surg. 2009;19(9):1203–10.

    Article  PubMed  Google Scholar 

  22. Burgos AM, Braghetto I, Csendes A, et al. Gastric leak after laparoscopic-sleeve gastrectomy for obesity. Obes Surg. 2009;19:1672–7.

    Article  PubMed  Google Scholar 

  23. Baker RS, Foote J, Kemmeter P, et al. The science of stapling and leaks. Obes Surg. 2004;14(10):1290–8.

    Article  PubMed  Google Scholar 

  24. Goto T, Kawasaki K, Fujino Y, et al. Evaluation of the mechanical strength and patency of functional end-to-end anastomoses. Surg Endosc. 2007;21(9):1508–11.

    Article  PubMed  CAS  Google Scholar 

  25. Consten EC, Gagner M, Pomp A, et al. Decreased bleeding after laparoscopic sleeve gastrectomy with or without duodenal switch for morbid obesity using a stapled buttressed absorbable polymer membrane. Obes Surg. 2004;14(10):1360–6.

    Article  PubMed  Google Scholar 

  26. Angrisani L, Cutolo PP, Buchwald JN et al. Laparoscopic reinforced sleeve gastrectomy: early results and complications. Obes Surg 2011 Apr 15. [Epub ahead of print]

  27. Sapala JA, Wood MH, Schuhknecht MP. Anastomotic leak prophylaxis using a vapor-heated fibrin sealant: report on 738 gastric bypass patients. Obes Surg. 2004;14(1):35–42.

    Article  PubMed  Google Scholar 

  28. Liu CD, Glantz GJ, Livingston EH. Fibrin glue as a sealant for high-risk anastomosis in surgery for morbid obesity. Obes Surg. 2003;13(1):45–8.

    Article  PubMed  Google Scholar 

  29. Baltasar A, Bou R, Bengochea M et al. Gastrectomía vertical laparoscópica con antrectomía parcial y parche de epiplón. Video. 6´.BMI 2011;1:34–5.

    Google Scholar 

  30. Kasalicky M, Michalsky D, Housova J, et al. Laparoscopic sleeve gastrectomy without an over-sewing of the staple line. Obes Surg. 2008;18(10):1257–62.

    Article  PubMed  Google Scholar 

  31. Dapri G, Cadière GB, Himpens J. Reinforcing the staple line during laparoscopic sleeve gastrectomy: prospective randomized clinical study comparing three different techniques. Obes Surg. 2010;20(4):462–7.

    Article  PubMed  Google Scholar 

  32. Chen B, Kiriakopoulos A, Tsakayannis D, et al. Reinforcement does not necessarily reduce the rate of staple line leaks after sleeve gastrectomy. A review of the literature and clinical experiences. Obes Surg. 2009;19(2):166–72.

    Article  PubMed  Google Scholar 

  33. Lalor PF, Tucker ON, Szomstein S, et al. Complications after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2008;4(1):33–8.

    Article  PubMed  Google Scholar 

  34. Basso N, Casella G, Rizzello M, et al. Laparoscopic sleeve gastrectomy as first stage or definitive intent in 300 consecutive cases. Surg Endosc. 2011;25(2):444–9.

    Article  PubMed  CAS  Google Scholar 

  35. Nocca D, Krawczykowsky D, Bomans B, et al. A prospective multicenter study of 163 sleeve gastrectomies: results at 1 and 2 years. Obes Surg. 2008;18(5):560–5.

    Article  PubMed  CAS  Google Scholar 

  36. Gonzalez R, Nelson L, Gallagher S, et al. Anastomotic leaks after laparoscopic gastric bypass. Obes Surg. 2004;14:1299–307.

    Article  PubMed  Google Scholar 

  37. Casella G, Soricelli E, Rizello M, et al. Nonsurgical treatment of staple line leaks after laparoscopic sleeve gastrectomy. Obes Surg. 2009;19:821–6.

    Article  PubMed  CAS  Google Scholar 

  38. Diamantis T, Alexandrou A, Pikoulis E, et al. Laparoscopic sleeve gastrectomy for morbid obesity with intra-operative endoscopic guidance. Immediate peri-operative and 1-year results after 25 patients. Obes Surg. 2010;20(8):1164–70.

    Article  PubMed  CAS  Google Scholar 

  39. Frezza EE, Barton A, Herbert H, et al. Laparoscopic sleeve gastrectomy with endoscopic guidance in morbid obesity. Surg Obes Relat Dis. 2008;4(5):575–9.

    Article  PubMed  Google Scholar 

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Acknowledgements

We would like to thank Dr. Aniceto Baltasar and Manuel Miras for their help.

Conflict of Interest

The authors (Manuel Ferrer-Márquez, Ricardo Belda-Lozano, and Manuel Ferrer-Ayza) declare that they have no conflict of interest.

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Correspondence to Manuel Ferrer-Márquez.

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Ferrer-Márquez, M., Belda-Lozano, R. & Ferrer-Ayza, M. Technical Controversies in Laparoscopic Sleeve Gastrectomy. OBES SURG 22, 182–187 (2012). https://doi.org/10.1007/s11695-011-0492-0

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