Stapleless laparoscopic sleeve gastrectomy. Preliminary report.

BACKGROUND: Laparoscopic sleeve gastrectomy (SG) as a single-stage procedure for the treatment of morbid obesity is becoming increasingly popular. In undeveloped countries, the linear staples required to create the sleeve are not always available because of their high cost. As an alternative to the staples, the bipolar vessel sealer device could be used in bariatric surgery to divide and temporarily seal the stomach. SETTINGS: Universidad Central de Venezuela, Caracas, Venezuela. METHODS: Between May 2015 and July 2016, 9 patients with a mean body mass index of 38.2 kg/m2 were submitted to a stapleless laparoscopic SG using the bipolar vessel sealer for the gastric division. The sleeve was performed over a 42 French bougie and closed with 2 layers of running sutures. Surgical time, morbidity, hospital stay, and excess weight loss were prospectively collected. RESULTS: Mean operative time and hospital stay were 117 min and 2.3 days. There was no major morbidity but 2 patients presented a basal atelectasis, which was solved by medical treatment without consequences. After a mean follow up of 6.8 months the mean excess weight loss was 78.4%. CONCLUSION: The technique of stapleless laparoscopic SG presented in this report is a valid alternative when these devices are not available. Large series with long-term follow-up are necessary to make definitive conclusions.

Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the treatment of morbid obesity. a prospective study with 5 years of follow-up.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most widely used bariatric procedures today, and laparoscopic sleeve gastrectomy (LSG) is becoming increasingly popular. The aim of this study was to compare mid-term results of both procedures. METHODS: From January 2008 to December 2008, 117 obese patients were assigned by patient choice after informed consent to either a LRYGB procedure (n=75) or a LSG procedure (n=42). We determined operative time, length of stay, morbidity, comorbidity outcomes, failures, and excess weight loss at 5 years. RESULTS: Both groups were comparable in demographic characteristics and comorbidities at baseline. No significant statistical differences were found in length of stay and early major morbidity, but mean operative time was shorter in LSG group, p<0.05. Follow-up was achieved in 74 patients (63.2 %) at 5 years, and major complications (early and late) were 10 (21.2 %) for the LRYGB group and 3 (11.1 %) for the LSG group, p>0.05. Five years after surgery, the percentage of excess weight loss was similar in both groups (69.8 % for LRYGB and 67.3 % for LSG, p>0.05). Failures were more common for LSG group, 22.2 versus 12.7 % for LRYGB group, but this difference was not significant, p>0.05. CONCLUSIONS: Both techniques are comparable regarding safety and effectiveness after 5 years of follow-up, so not one procedure is clearly superior to the other.

Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the treatment of morbid obesity. A prospective study of 117 patients.

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most widely used bariatric procedures today, and laparoscopic sleeve gastrectomy (LSG) as a single-stage procedure for the treatment of morbid obesity is becoming increasingly popular. In this study, we prospectively compared both techniques in order to establish whether there is any superiority of one over the other based on morbidity and effectiveness. From January 2008 to December 2008, 117 obese patients with indication for bariatric surgery were assigned by patient choice after informed consent to either a LRYGB procedure (n = 75) or a LSG procedure (n = 42). We determined operative time, length of stay, morbidity, co-morbidity outcomes, and excess weight loss at 1 year postoperative. Both groups were comparable in age, sex, body mass index, and co-morbidities. Mean operative time of LSG was 82 min while LRYGB was 98 min (p < 0.05). Differences in length of stay, major complications, improvement in co-morbidities, and excess weight loss were not significant (p > 0.05). One year after surgery, average excess weight loss was 86% in LRYGB and 78.8% in LSG (p > 0.05). In the short term, both techniques are comparable regarding safety and effectiveness, so not one procedure is clearly superior to the other.

Laparoscopic gastric bypass for morbid obesity-a randomized controlled trial comparing two gastrojejunal anastomosis techniques.

OBJECTIVES: We present a randomized controlled trial of laparoscopic gastric bypass comparing 2 techniques of gastrojejunostomy in patients with morbid obesity. METHODS: Eighty consecutive patients underwent laparoscopic Roux-en-Y gastric bypass between September 2005 and August 2006. Patients were randomly assigned to 2 groups by the use of sealed envelopes. In group A, the gastrojejunal anastomosis was performed with a 21-mm circular-stapler, and in group B, this anastomosis was performed with a 45-mm linear-stapler. The rest of the procedure was identical in both groups. Variables evaluated were complications involving the gastrojejunostomy, operative time, length of stay, and percentage of excess weight loss. RESULTS: Both groups were similar in age and body mass index. No patients experienced leakage or gastrojejunal anastomosis fistula, but group A patients had a more frequent stricture rate (P<0.05). Operative time and hospital stay were comparable in both groups (P>0.05). Percentage excess weight loss at one year following surgery was satisfactory in both groups, without a statistically significant difference (P>0.05). CONCLUSION: Gastrojejunal anastomosis does not seem to be a critical factor in excess weight loss for morbidly obese patients who underwent laparoscopic gastric bypass. The 2 techniques used in this experience are safe and effective; however, the 45-mm liner-stapler is preferable because it has a lower stricture rate.

Laparoscopic diagnosis and treatment in gynecologic emergencies.

OBJECTIVE: To present an analysis of our experience with 22 consecutive cases of acute abdominal gynecologic emergencies managed with a laparoscopic approach. METHODS: From March 1997 to October 1998, 22 patients with a diagnosis of acute abdominal gynecologic emergencies underwent laparoscopic intervention. A transvaginal ultrasound was performed on all patients preoperatively to supplement the diagnostic workup. Surgical time, complications, and length of hospital stay were evaluated, and the laparoscopic diagnosis was compared with the preoperative diagnosis. RESULTS: The laparoscopic diagnosis was different from the preoperative diagnosis in 31.8% of patients. Of the 22 patients, laparoscopic therapeutic procedures were performed in 18 (81.8%), all satisfactorily, and with no need for conversion to open surgery. No morbidity or mortality occurred. CONCLUSION: Laparoscopy is a safe and effective method for diagnosing and treating gynecologic emergencies.