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Technical Aspects of Laparoscopic Sleeve Gastrectomy in 25 Morbidly Obese Patients

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Background

Laparoscopic sleeve gastrectomy (LSG) has recently come to be performed as a sole bariatric operation. The postoperative morbidity and mortality are cause for concern, and possibly are related to non-standardized surgical technique.

Methods

The following is the surgical LSG technique used in 25 morbidly obese patients. Five trocars are used. Division of the vascular supply of the greater gastric curvature is begun at 6–7 cm proximal to the pylorus, proceeding to the angle of His. A 50-Fr calibrating bougie is positioned against the lesser curvature. The LSG is created using a linear staplercutter device with one 4.1-mm green load for the antrum, followed by five to seven sequential 3.5-mm blue loads for the remaining gastric corpus and fundus. The staple-line is inverted by placing a seroserosal continuous absorbable suture over the bougie from the angle of His .The resected stomach is removed through the 12-mm trocar, and a Jackson-Pratt drain is left along the suture-line.

Results

The mean operative time was 120 minutes, and length of hospital stay was 4 ± 2 days.There were no conversions to open procedures. There were no postoperative complications (no hemorrhage from the staple-line, no anastomotic leakage, no stricture) and no mortality. In 1 patient, cholecystectomy was also done, and in 4, a gastric band was removed. During a median follow-up of 4 months, BMI decreased from 43 ± 5 kg/m2 to 34 ± 6 kg/m2, and the % excess BMI loss was 49 ± 25%.

Conclusions

The proposed surgical technique appears to be a safe and effective procedure for morbid obesity.

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Authors and Affiliations

  1. Department of Surgery “B”, Felsenstein Research Center, Rabin Medical Center, Petah Tiqva, Israel

    Osnat Givon-Madhala MD, Rona Spector MD, Nir Wasserberg MD, Michael Stein MD, Nazik Arar MD & Moshe Rubin MD

  2. Department of Surgery, Hadassah University Hospital, Mount Scopus, Jerusalem, Israel

    Nahum Beglaibter MD

  3. Clinical Nutrition Unit, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel

    Hagit Lustigman BA

  4. Department of Surgery “B”, Rabin Medical Center, Beilinson Campus, Petah Tiqva, 49100, Israel

    Moshe Rubin MD

Authors
  1. Osnat Givon-Madhala MD
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  2. Rona Spector MD
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  3. Nir Wasserberg MD
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  4. Nahum Beglaibter MD
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  5. Hagit Lustigman BA
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  6. Michael Stein MD
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  7. Nazik Arar MD
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  8. Moshe Rubin MD
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Corresponding author

Correspondence to Moshe Rubin MD.

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Givon-Madhala, O., Spector, R., Wasserberg, N. et al. Technical Aspects of Laparoscopic Sleeve Gastrectomy in 25 Morbidly Obese Patients. OBES SURG 17, 722–727 (2007). https://doi.org/10.1007/s11695-007-9133-z

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  • DOI: https://doi.org/10.1007/s11695-007-9133-z

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