Misadventure during laparoscopic sleeve gastrectomy: why it happened? how to prevent and recover from it?

Background:Laparoscopic gastrectomy has numerous perioperative advantages, but the long-term survival of patients after this procedure has been less studied. Aim:To compare survival, oncologic and perioperative outcomes between completely laparoscopic vs. open gastrectomy for early gastric cancer. Methods:This study was retrospective, and our main outcomes were the overall and disease-specific 5-year survival, lymph node count and R0 resection rate. Our secondary outcome was postoperative morbidity. Results:Were included 116 patients (59% men, age 68 years, comorbidities 73%, BMI 25) who underwent 50 laparoscopic gastrectomies and 66 open gastrectomies. The demographic characteristics, tumour location, type of surgery, extent of lymph node dissection and stage did not significantly differ between groups. The overall complication rate was similar in both groups (40% vs. 28%, p=ns), and complications graded at least Clavien 2 (36% vs. 18%, p=0.03), respiratory (9% vs. 0%, p=0.03) and wound-abdominal wall complications (12% vs. 0%, p=0.009) were significantly lower after laparoscopic gastrectomy. The lymph node count (21 vs. 23 nodes; p=ns) and R0 resection rate (100% vs. 96%; p=ns) did not significantly differ between groups. The 5-year overall survival (84% vs. 87%, p=0.31) and disease-specific survival (93% vs. 98%, p=0.20) did not significantly differ between the laparoscopic and open gastrectomy groups. Conclusion:The results of this study support similar oncologic outcome and long-term survival for patients with early gastric cancer after laparoscopic gastrectomy and open gastrectomy. In addition, the laparoscopic approach is associated with less severe morbidity and a lower occurrence of respiratory and wound-abdominal wall complications.

Section: Discussionmentioning

confidence: 99%

Survival and Perioperative Morbidity of Totally Laparoscopic Versus Open Gastrectomy for Early Gastric Cancer: Analysis From a Single Latin American Centre

Norero¹,

Vargas²,

Achurra³

et al. 2019

“…To combat this disease, clinical treatment is the first approach and contemplates the implementation of special diets, psychotherapy, physical activity and pharmacotherapy 18 . However, clinical therapy for obesity, especially for severe obesity (BMI greater than 35 kg/m²), has limited short-term success and almost non-existent in the long term compared to surgical treatment 19 , 27 , 28 .…”

Section: Introductionmentioning

confidence: 99%

Quality of Life After Vertical Gastrectomy Evaluated by the Baros Questionnaire

Vargas

MENDES

Pinto³

2017

Background : The satisfactory outcome in the surgical treatment of obesity must include, in addition to weight loss, a significant change in the pre-existing comorbidities and in the quality of life of the patients. Aim : To evaluate the quality of life in the late postoperative period in patients that underwent videolaparoscopic sleeve gastrectomy. Methods : Was applied the questionnaire “Bariatric Analysis and Reporting Outcome System” (BAROS) in patients that underwent videolaparoscopic sleeve gastrectomy. Results : A total of 47 patients between 21-60 years old were evaluated. The total mean of the BMI before surgery was 43.06±5.87 kg/m². The average percentage of the reduction of excess weight after surgery was 85.46±23.6%. The score obtained by patients in the questionnaire about the improvement in the quality of life showed excellent (36.17%), very good (40.43%), good (21.28%) and reasonable (2.13%) results. There was clinical improvement after surgery in all comorbidities investigated. Conclusion : BAROS showed excellent results in 36.17%, very good in 40.43%, good in 21.28% and reasonable in 2.13%. The weight loss was critical to improve the quality of life and offered the resolution or clinical improvement in all of the investigated comorbidities.

Quality of Life After Vertical Gastrectomy Evaluated by the Baros Questionnaire

MENDES

Vargas

2017

Background: The satisfactory outcome in the surgical treatment of obesity must include, in addition to weight loss, a significant change in the pre-existing comorbidities and in the quality of life. Aim: To evaluate the quality of life in the late postoperative period in patients that underwent videolaparoscopic sleeve gastrectomy. Methods: It was applied the questionnaire "Bariatric Analysis and Reporting Outcome System" (BAROS) in patients that underwent videolaparoscopic sleeve gastrectomy. Results: A total of 47 patients between 21-60 years old were evaluated. The total mean of BMI before surgery was 43.06±5.87 kg/m². The average percentage of the reduction of excess weight after surgery was 85.46±23.6%. The score obtained by patients in the questionnaire about the improvement in the quality of life showed excellent (36.17%), very good (40.43%), good (21.28%) and reasonable (2.13%) results. There was clinical improvement after surgery in all comorbidities investigated. Conclusion: The weight loss was critical to improve the quality of life and offered the resolution or clinical improvement in all of the investigated comorbidities in patients submitted to sleeve gastrectomy.