Laparoscopic adrenalectomy by transabdominal lateral approach: 20 years of experience.

BACKGROUND: Laparoscopic adrenalectomy (LA) has become the standard technique for most indications. The aim of this study was to determine the predictive factors of intra- and postoperative complications in order to inform the orientation of patient to a surgeon with more experience in adrenal surgery. METHODS: From January 1994 to December 2013, 520 consecutive patients benefited from LA at Huriez Hospital, Lille, France. Each complication was graded according to the Dindo-Clavien-grade scale. The predictive factors of complications were determined by logistic regression. RESULTS: Fifty-two surgeons under the supervision of 5 senior surgeons (individual experience >30 LA) participated. Postoperative complications with a grade of ≥2 occurred in 52 (10 %) patients (29 (5.6 %) medical, 19 (3.6 %) surgical, and 4 (0.8 %) mixed complications) leading to 12 (2.3 %) reoperations. There was no postoperative death. Intraoperative complication happened in 81 (15.6 %) patients responsible for conversion to open adrenalectomy (OA) [odds ratio (OR) 13.9, CI 95 % 4.74-40.77, p < 0.001]. History of upper mesocolic or retroperitoneal surgery was predictive of intraoperative complication (OR 2.02, 1.05-3.91, p = 0.036). Lesion diameter ≥45 mm was predictive of intraoperative complication (OR 1.94, 1.19-3.15, p = 0.008), conversion to OA (OR 7.46, 2.18-25.47, p = 0.001), and adrenal capsular breach (OR 4.416, 1.628-11.983, p = 0.004). Conversion to OA was the main predictive factor of postoperative complications (OR 5.42, 1.83-16.01, p = 0.002). Under adequate supervision, the surgeon's individual experience and initial adrenal disease were not considered predictive of complications. CONCLUSION: Lesion diameter over 45 mm is the determinant parameter for guidance of patients to surgeons with more extensive experience.

Revised Sleeve Gastrectomy: Our Experience.

Introduction: Laparoscopic sleeve gastrectomy (LSG) has rapidly become increasingly popular in bariatric surgery. However, in the long-term follow-up, weight loss failure and intractable severe acid reflux after primary LSG can necessitate further interventions. The purpose of this study was to evaluate our initial case series regarding the complications and short-term weight loss results of the ReSleeve Gastrectomy (ReSG). Methods: From January 2010 to February 2016, all patients who underwent ReSG were included in this study. From a retrospective database, the demographic data, surgical history, comorbidities, American Society of Anaesthesiologists (ASA) score, time interval between the two procedures, and intra- and postoperative parameters and outcomes were analyzed. Results: ReSG was performed for 25 patients (7 men) with a mean age of 49 years (±11). Indications for ReSG were weight loss insufficiency for 1 patient (4%), weight regain for 23 patients (92%), and an acute dysphagia due to a residual fundic pouch for 1 patient (4%). Mean reoperation time before ReSG was 2.9 years (±1.5). The mean body mass index (BMI) for ReSG was 43.9 kg/m2 (±9.4). The first 4 patients (16%) had a barium swallow and the next 21 (84%) patients a computed tomography scan volumetry with a mean gastric volume of 526.7 cc (±168). All procedures were completed by laparoscopy with no intraoperative complication. An additional procedure was carried out for 3 patients (12%), including 1 cholecystectomy and 2 hiatal hernia repairs. Mean length of hospital stay was 5.2 days (±4.2), with no postoperative death. The complication rate was 60% (n = 15) including a Dindo-Clavien grade 2 complication for 7 patients (28%) and grade 3 for 8 patients (32%). One patient was lost to follow-up (4%). The mean BMI before RSG was 43.9 kg/m2 (±9.4). At a mean follow-up after ReSG of 37.3 months (range 6-80), the mean BMI and percentage of excess weight loss were, respectively, 35 kg/m2 (±6.7) and 38.2% (±19). Conclusions: ReSG should be proposed only for well-selected cases. This study has led us to change our habits by selecting only patients with a large gastric pouch ≥500 mL or with unresected fundus. Further prospective clinical trials are required to compare the outcomes of ReSG with those of laparoscopic Roux-en-Y gastric bypass or duodenal switch for weight loss failure after LSG.