Totally Laparoscopic Transgastric Resection of a Gastric Submucosal Fibrolipoma and Concomitant Sleeve Gastrectomy in a Morbidly Obese Patient.

INTRODUCTION: To evaluate feasibility and safety of a totally laparoscopic transgastric resection with concomitant sleeve gastrectomy in a morbidly obese presenting with benign lesion located along the lesser gastric curvature. MATERIALS AND METHODS: We report the case of a morbidly obese patient with an incidental submucosal lesion of the lesser curvature radiologically consistent with fibrolipoma at preoperative work-up. Benign nature of the mass was then confirmed EUS-biopsy. RESULTS: A combinated laparoscopic transgastric approach was successfully attempted resulting in a complete excision of the submucosal lesion and concomitant sleeve gastrectomy. Intraoperative and definitive histology confirmed the benign nature of the mass. Postoperative course was uneventful. CONCLUSION: Concomitant transgastric resection of submucosal benign lesions during laparoscopic sleeve gastrectomy represents both a safe and feasible surgical approach in morbidly obese patients. Preoperative work-up is of great importance in order to assess the benign nature of the lesion.

Enhanced Recovery after Bariatric Surgery: 202 Consecutive Patients in an Italian Bariatric Center.

BACKGROUND: Enhanced Recovery After Surgery (ERAS) pathways have been shown to improve postoperative outcomes. However, its application in bariatric surgery is still limited. The aim of the study was to define the safety of ERAS in bariatric patients with regard to postoperative complications, length of hospital stay (LOS), and readmission rates within 30 days from surgery. METHODS: The effectiveness and safety of an ERAS protocol was prospectively investigated in morbidly obese patients who underwent bariatric surgery in a single-institute experience over a 2-year period. RESULTS: Between June 2016 and September 2018, a total of 89 laparoscopic sleeve gastrectomy (SG), 105 Roux-en-Y gastric bypass (RYGB), and 8 one-anastomosis gastric bypass (OAGB) were performed. Twenty patients (9.9%) were revisional cases. Mean (standard deviation, SD) BMI and age at time of surgery were 43.2 (± 6.2) kg/m2 and 46 (± 11.3) years, respectively. Median (range) surgical time was 118 (45-255) minutes. Overall postoperative complication rate was 7.4%, with 6 (3.0%) patients developing grade III-IV complications according to the Clavien-Dindo classification. Median (range) LOS was 2 (1-50) days, with mean (SD) LOS of 2.3 (± 3.6) days. Overall, 36.6% of patients were discharged by first postoperative day and 77.7% by second postoperative day. Readmission rate was 4.5%. No mortality was observed during the study period. CONCLUSIONS: According to the results of the present study, ERAS in primary and revisional bariatric surgery is safe and feasible, with short LOS, low morbidity and readmission rates, and no mortality. A significant reduction of mean LOS was progressively noted over the study period.