Abstract:

Sleeve gastrectomy (SG) is a surgical procedure that includes a longitudinal lateral gastrectomy to reduce food intake by reducing the capacity of the stomach. The technique of SG as a primary procedure has evolved since it was first introduced in 2001. Some perform the SG over smaller bougie sizes (30-40 Fr) or an NG tube. Some begin the SG near the pylorus (2cm) while others avoid the antral/pyloric area. Establishing the mass or volume of stomach remaining is subject to limitations associated with the in vivo status. However, quantifying the amount (mass) of stomach removed is definitively an objective measure. The study was conducted to determine the relationship between the amount of stomach excised and the patient's gender and preoperative weight and height. Data was collected prospectively and was compiled in a review of 165 (136 Female and 29 Male) patients who underwent laparoscopic SG from December 7, 2001 to March 18, 2004 by a single surgeon at three institutions using the same technique for performance and measurement. The empty weight and capacity of resected stomach specimens were measured intra-operatively and subsequently correlated with the patient's gender, preoperative weight, and height. The mean height of male patients was 179.7+/-7.1 (CM) and the mean height of female patients was 165.1+/-7.1(CM). The mean weight of stomach tissue removed from male patients was 160.3 +/-29.4 (G) and from female patients was 123.5 +/-40.4 (G). The difference in height and weight between men and women was statistically significant (P-value<0.0001). The empty stomach weight and capacity both are linearly related to each other (R-square=0.9292, P-value<.0001). There is evidence showing the statistically significant correlation among preoperative height, gender, and preoperative weight and amount of stomach removed. For the average height patient, removal of gastric tissue weighing less than 160 grams in males and 120 grams in females may indicate an inadequate resection. This removes a stomach capacity of approximately 1600 cc's and 1200 cc's respectively.

Authors:

Yaqub M. Baraki, MD, Purnel Traverso, MD, Hazem A. Elariny, MD, PhD, FACS, Yun Fang

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Abstract:

Laparoscopic gastric banding is now well established as an effective means of obtaining safe, healthy weight loss in the morbidly obese patient population. The procedure has evolved over the years to minimize complications and optimize results. Preoperative patient evaluation includes upper endoscopy to assess the baseline integrity of the stomach and rule out pathology. Upper endoscopy fails to demonstrate the majority of small hiatal hernias in these patients preoperatively. Hiatal hernias are grossly underappreciated in patients with morbid obesity due to the presence of a large distal esophageal fat pad. With post-operative internal weight loss, a small crural defect can become relatively large in a short amount of time. Performing gastric banding without dissecting and repairing the hiatal hernia can lead to incorrect positioning of the gastric band, which is associated with poor weight loss, chronic reflux, and increased complications. Concomitant hiatal hernia repair is felt by the authors to be a necessary component for the correct placement of the gastric band device, which, in turn, provides excellent long-term results to our patients.

Authors:

Jonathan Reich, MD, FACS, Karl Strom, MD, FACS, James Pasquariello, MD, Silvia Fresco, MD, FACS, Joseph Barbalinardo, MD, FACS

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Abstract:

Revision of gastric bypasses that fail is one of the most difficult challenges that face bariatric surgeons these days. Adding a foreign body like a band or a silastic may give unsatisfactory results, while increasing malabsorption may result in severe malnutrition and hypoproteinemia. Laparoscopic jejunal sleeve is based on the principles of laparoscopic sleeve gastrectomy applied to a failed Roux-en-Y gastric bypass. The procedure is simple and involves only stapling, is reproducible, accessible, effective, and safe, without foreign bodies. Weight loss may be achieved to give an extra 5 to 10 points of BMI reduction. Early complications are similar to laparoscopic sleeve gastrectomy and may involve leaks and strictures. Mid- and long-term weight loss data are lacking at the present time, and patients should be selected based on an initial response to their gastric bypass.

Authors:

Michel Gagner, MD, FRCSC, FACS, FICS, FASMBS

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Abstract:

As the prevalence of obesity has dramatically increased and obesity has become one of the leading public health threats worldwide, the number of bariatric surgeries performed has been exponentially increasing. According to a recent survey, over 90% of bariatric procedures are performed by laparoscopic approach. The most commonly performed procedures are Roux-en-Y gastric bypass (open and laparoscopic), followed by laparoscopic adjustable gastric banding, and sleeve gastrectomy. Definite geographic trends are observable in the specific bariatric procedures being performed. A number of studies have already demonstrated the efficacy of bariatric surgery for the treatment of obesity and its comorbidities, although there are still only a handful of prospective, controlled studies with a high level of evidence. Considering the results derived from a large-scale, prospective, multicenter study and a systematic review, it can be reasonably said that bariatric surgery is a safe and feasible intervention for the treatment of life-threatening morbid obesity under controlled conditions. So far, several studies have shown improved survival rates for patients who undergo bariatric surgery compared with a control cohort of severely obese patients who did not. In addition, bariatric surgery seems to have a positive impact on the economy, although currently only about 1-2% of eligible patients with morbid obesity receive bariatric surgery. In this mini-review article, we summarize bariatric surgery outcomes by quoting some of the recently published landmark articles.

Authors:

Yosuke Seki, MD, PhD, Kazunori Kasama, MD, FACS

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