Laparoscopic Sleeve Gastrectomy Smart Trocar Site Modification in Patients with Extreme Obesity.

PURPOSE: Laparoscopic sleeve gastrectomy (LSG) is one of the most common bariatric surgeries performed worldwide. Although it has established itself as a satisfactory procedure on its own, it can also function as the first part of a two-stage treatment strategy. This is especially true in situations of extreme obesity (obesity grade IV or higher). One rationale for choosing a two-stage treatment is the technical difficulty of doing other types of bariatric procedures involving anastomoses due to body physique and level of visceral adiposity. LSG in patients with such a high body mass index (BMI) is comparatively simpler technically, but it does also have a degree of complexity for similar reasons. Here, we present an innovative port configuration for LSG that can significantly reduce ergonomic challenges and enhance the safety of the procedure in patients with extreme obesity. MATERIALS AND METHODS: This new trocar site arrangement is generally suitable for individuals with grade IV obesity or above. It is especially effective for people with obesity at or above grade V. Only standard laparoscopic instruments are used. RESULTS: This design preserves the ideal manipulation and elevation angles at 60° and allows surgeons to use standard laparoscopic instruments with lowered shoulders, reducing muscular strain and fatigue. Additionally, it improves patient safety. CONCLUSION: In patients with extreme obesity, this proposed port configuration for LSG can significantly reduce ergonomic difficulties and increase surgical safety.

Evaluation of the Incidence of Low Testosterone Levels in Young Male Adults with Moderate to Severe Obesity-Single-Centre Study from India.

PURPOSE: With the increase in obesity epidemic among Asians, it is necessary to evaluate the impact of obesity on this population. Low testosterone levels are known to be associated with obesity. This is the 1st study from Asia to evaluate incidence and magnitude of hypotestosteronemia in young adults with BMI more than 32.5 kg/m2 defined as moderate to severe obesity in Asians. MATERIALS AND METHODS: One hundred thirty-four male patients with BMI more than 32.5 kg/m2, between 18 and 30 years old who visited a single bariatric facility between 2017 and 2020, were evaluated with BMI, total and free testosterone levels and clinical features of gynecomastia, hypogonadism, and thinning of pubic and armpit hair. Statistical analysis was performed using SPSS, Spearman's correlation coefficient, and ANOVA test. RESULTS: 60.4% of patients (84/134) had low testosterone levels (< 300 ng/dl) and 23.9% (32/134) had levels between 300 and 400 ng/dl. 89.6% patients (120/134 had gynecomastia, 60.4% (81/134) had thinning of pubic and arm pit hair, and 62.7% (84/134) had hypogonadism. Testosterone levels showed a decreasing trend with increasing BMI, but it was not statistically significant. CONCLUSION: Obesity is one of the important etiologies of hypotestosteronemia and its manifestations in young adults. The actual incidence may be significantly higher than what is reported in the literature. High-quality research is required to address questions of diagnosis and best treatment options.