Claves técnicas en la realización de la gastrectomía vertical para evitar complicaciones

  1. J. M. Pacheco-García 1
  2. Mª Angeles Mayo Ossorio 1
  1. 1 Hospital Universitario Puerta del Mar, Cádiz.
Journal:
Cirugía Andaluza

ISSN: 2695-3811,  1130-3212

Year of publication: 2017

Volume: 28

Issue: 1

Pages: 34-38

Type: Article

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Abstract

Introduction: sleeve gastrectomy (SG) has established itself as a primary bariatric technique with wide distribution and acceptance by patients and surgeons. This success is based in its apparent technical ease and low risk of complications. However, complications are important. The aim of this work is to communicate how we perform the SG in our group. Methods: our patients are optimized preoperatively. The patient is placed with legs spread in semi-sitting position at the table of conventional surgery. Usually, we use five trocars and performed a SG preserving the antrum, tutoring with a 34 Fr Fouchet, gastric section beginning at 6 cm from the pylorus, with 60 mm mechanical Flex endostapler (first green and gold charge for the remaining firings) protected with a Seamguard®. Blake drainage along gastric section is placed and we never place a nasogastric tube. Discussion: controversial aspects of the technique, especially the bougie size, use of energy devices, size of the antral resection management of the gastroesophageal junction, size of the staples and the staple line reinforcement are discussed. Conclusions: laparoscopic gastrectomy has become a primary bariatric technique offering good results with few complications. However, there may be serious complications such as leakage, bleeding and stenosis. To reduce these complications is essential to improve the implementation and standardization of the surgical technique.

Bibliographic References

  • Ren CJ, Patterson E, Gagner M. Early results of laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients. Obes Surg. 2000;10(6):514-23.
  • Regan JP, Inabnet WB, Gagner M, et al. Early experience with two-stage laparoscopic Roux-en-Y gastric by pass as an alternative in the super-super obese patient. Obes Surg. 2003;13(6):861-4.
  • Angrisani L, Santonicola A, Iovino P, Formisano G, Buchwald H, Scopinaro N. Bariatric Surgery Worldwide 2013. Obes Surg. 2015;25:1822-1832.
  • Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Anna inter med. 2005;142:547-59.
  • Buchwald H, Avidor Y, Braunwald E, et al. Bariatric Surgery: a systematic review and meta-analysis. Jam. 2004;292:1724-37.
  • Sanchez-Santos R, Masdevall C, Baltasar A, Martínez-Blázquez C, García Ruiz de Gordejuela A, Ponsi E, et al. Short- and Mid-term Outcomes of Sleeve Gastrectomy for Morbid Obesity: The Experience of the Spanish National Registry. Obes Surg 2009;19:1203-1210.
  • Rosenthal RJ, et al. International Sleeve Gastrectomy Expert Panel Cosensus Statement: best practice guidelines based on experiencie of >12.000 cases. Surg Obes Relat Dis 2012;8:8-19.
  • Vilchez López FJ, Campos Martín C, Amaya García MJ, Sánchez Vera P, Pereira Cunill JL. Las dietas de muy bajo valor calórico (DMBVC) en el manejo clínico de la obesidad mórbida. Nutr Hosp. 2013;28(2):275-285.
  • Weiner RA, Weiner S, Pomhoff I, et al. Laparoscopic sleeve gastrectomy-influence of sleeve size and resected gastric volume. Obes Surg. 2007;17:1297-305.
  • Nguyen NT, Longoira M, Gelfand DV, et al. Staged laparoscopic Roux-en-Y: a novel two-stage bariatric operation as an alternative in the super-obese with massively enlarged liver. Obes Surg. 2005;15:1077-81.
  • Morales Conde S, Rubio Manzanares Dorado M, Barranco Moreno A, Alarcón I, Pereira Cunill JL, et al. Single-port Roux-en-Y gastric bypass: Howard a less invasive procedure with the same surgical results and a better cosmesis. Surgical Endoscopy 2013;27:4347-4353.
  • Tsamis D, Natoudi M, Arapaki A, et al. Using Ligasure or Harmonic Ace in laparoscopic sleeve gastrectomy? A prospective randomized study. Obes Surg. 2015;25(8):1454-7.
  • Baltasar A, Serra C, Pérez N, et al. Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obes Surg. 2005;15(8):1124-8.
  • Bellanger DE, Greenway FL. Laparoscopic Sleeve Gastrectomy, 519 Cases Without a Leak: Short-Term Results and Technical Considerations. Obes Surg. 2011;21:146-150.
  • Gagner M. Leaks after sleeve gastrectomy are associated with smaller bougies : prevention and treatment strategies. Surg Laparosc Endosc Percutan Tech. 2010;20:166-9.
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