Laparoscopic Sleeve Gastrectomy for Morbid Obesity with Intra-operative Endoscopic Guidance. Immediate Peri-operative and 1-year Results after 25 Patients

Abstract

Laparoscopic sleeve gastrectomy (LSG) represents a promising alternative option for the surgical treatment of morbid obesity. Its standard technique includes the longitudinal division of the stomach along a bougie of varying diameter. We report in this retrospective study our experience with LSG being performed with the use of intra-operative endoscopy instead of the bougie. Twenty-five consecutive patients (18 women, seven men) with a mean age of 40.2 years and mean body weight of 152.1 kg were submitted to LSG with intra-operative endoscopy in our hospital. The mean preoperative BMI was 53.5 kg/m(2). There were no conversions. Mean operative time was 117.5 min. There was no morbidity or mortality. The mean loss of excess body weight (EBW) at 3 months post-op was 19 +/- 1.8 kg, at 6 months was 28.6 +/- 4.5 kg, and at 1 year post-op was 48.9 +/- 3.7 kg (min 11-max 92). In other words the patients had lost 30 +/- 5%, 45 +/- 7.7%, and 60.8 +/- 4.3% of their EBW, respectively. The mean excess body weight loss at the day of the last visit to our outpatient clinic was 52.3 +/- 4.3 kg which corresponded to 66.4 +/- 4.3% of the total excess weight. LSG with intra-operative endoscopic guidance is a safe and efficient alternative method to treat morbid obesity and is a viable option for surgical units familiar with endoscopic techniques.

Technical Controversies in Laparoscopic Sleeve Gastrectomy

“…Once the gastric tube is inserted, the endoscope insufflates a minimal amount of air in order to inspect the staple line from the gastric interior in search of points of bleeding or suspected disruption in the staple line. At the same time, laparoscopic vision confirms the absence of bubbles as if it were an air test (38). Similarly, Frezza et al use a 29F endoscope that serves, firstly, as a bougie to perform the section and also to test, at the end of the procedure, the integrity of the gastric tube and seal from an internal viewpoint (39).…”

Laparoscopic Sleeve Gastrectomy for Morbid Obesity with Intra-operative Endoscopy: Lessons We Learned After 100 Consecutive Patients

“…We have already reported, which are, according to our experience, the advantages and the drawbacks of intra-operative endoscopy for the performance of LSG [7]. Briefly, the former include the reliable and controlled advancement of the illuminated tip of the scope by us, instead of the blind insertion performed by the anesthesiologists, its' more accurate positioning along the lesser curvature, the ensuing confirmation of the patency of the gastric remnant at the end of the procedure, and the ability to check from the inner part of the staple line for any bleeding or suspicious for a leak point during the withdrawal of the endoscope.…”

“…Our technique has already been reported [7,8]. Briefly, our main modification of the so-called standard technique is that we used intra-operative endoscopic guidance instead of a bougie in order for calibration of the gastric sleeve.…”

“…Very early in our experience, we decided to apply intra-operative endoscopic guidance for the calibration of the gastric sleeve instead of the commonly used bougie and we have already reported our initial experience [7]. Since 2008, we have also used the Da Vinci Surgical System for the performance of LSG (robotic sleeve gastrectomy, RSG) and we were actually among the first to report our initial experience with it, with equally good results as with conventional LSG [8].…”

Benefits of Intraoperative Endoscopy: Case Report and Review of 300 Sleeves Gastrectomies

“…Only two reports describe the use of intraoperative endoscopy thus far. Diamentis et al [5] reports their experience with 25 patients. The mean operative time was 117 min, longer than our time.…”