Gastroscopically controlled laparoscopic sleeve gastrectomy

Abstract

Background: Laparoscopic sleeve gastrectomy is becoming increasingly established as a stand-alone procedure for weight reduction. The restrictive as well as humoral characteristics of this operation assure postoperative weight loss of up to 70-80% after 1 year. Complications also occur with this procedure.

Methods: The technical details of the sleeve gastrectomy surgical procedure are described, while elaborating on potential complications and on calibration. In our case, we perform gastrectomy under intraoperative gastroscopic control for calibration as well as for suture control as a standard procedure. As a general practice, the staple line is reinforced with the bioabsorbable material Seamguard.

Results: Since June 2006, 38 patients have undergone sleeve gastrectomy.Postsurgical bleeding occurred in 1 case (2.6%) and had to be treated surgically. 1 patient developed cicatricial stenosis and required dilatation (2.6%). After 1 year, 85% of patients had a weight loss of 70-80%.

Conclusion: Thanks to the standardisation of this procedure using staple line reinforcement and intraoperative gastroscopic control, the complication rate can be reduced and the successful outcome of this stand-alone,weight-reduction operation can be optimised.

Fig. 1

Mobilisation of the stomach with dissection of the short gastric vessels with the ultrasonic dissector.

Fig. 2

Placement of a gastroscope for determination of gastrectomy limits and gastric visualisation during gastrectomy and oversewing.

Fig. 3

Dissection of the gastric wall with the stapler device. In addition, staple line reinforcement (Seamguard) is used.

Fig. 4

Final oversewing of the entire staple line with continuous Endoclip suture.