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Laparoscopic Sleeve Gastrectomy for Morbid Obesity with Intra-operative Endoscopy: Lessons We Learned After 100
Alexandrou Andreas1, Michalinos Adamantios, Athanasiou Antonios
11st Surgery Department, Laikon General Hospital, National and Kapodistrian University of Athens, Agiou Thoma 17, Athens, Greece, antreasalexandrou@hotmail.com.
Background:
Sleeve gastrectomy has become the second most common bariatric operation due to its low rates of morbidity and mortality, satisfactory treatment of patients' obesity, and resolution of associated co-morbidities. According to standard technique, calibration of the stomach is performed with varying sizes of bougies while use of intra-operative endoscopy has only sparsely been reported.
Methods:
Between 2004 and 2013, 100 patients have undergone laparoscopic or robotic sleeve gastrectomy with intra-operative endoscopic guidance. Technical aspects of the operation, results concerning morbidity, progressive weight loss, and resolution of co-morbidities were retrospectively reviewed.
Results:
Morbidity and mortality was zero. Rates of excess weight loss at 6 months and 1 and 3 years were 52.1, 67.4, and 61.3 %, respectively. Patients' highest rate of excess weight loss was achieved 18 months post-operatively. These rates were inversely related with preoperative age, body mass index, and the existence of preoperative co-morbidities.
Conclusion:
Sleeve gastrectomy with intra-operative endoscopic guidance is at least as safe and effective as with the bougie. Given the available expertise and equipment, the use of this technique can increase the intra-operative sense of safety with no compromise or even improvement of the immediate or long-term results.
