Abstract
Background Sleeve gastrectomy is the most commonly performed bariatric procedure. Laparoscopic longitudinal gastrectomy (LLG) may be indicated for other indications. Patients and Methods. Two men and two women aged 67, 72, 77, and 80 years underwent LLG for nonbariatric indications with two having normal weight, one being cachectic, and one severely obese. Results LLG was discussed with patients prior to surgery, but decision for LLG was made during surgery after contemplating other surgical options. A wide sleeve over a 42 French bougie was created with the staple line being oversewn with running 3–0 silk. Indications included a bleeding Dieulafoy lesion that failed endoscopic clipping, fundus gland polyposis found during paraesophageal hernia repair, fundus nodules suspected to be leiomyosarcoma metastases revealing splenosis on final pathology, and significant gastric dilatation associated with organoaxial gastric volvulus. Three patients had an uneventful recovery; the severely obese patient temporarily lost weight but died after two years from a stroke. The last patient developed dysphagia due to an alpha-loop in the sleeve, which was managed by endoscopic stenting. The device subsequently migrated and was laparoscopically removed, with a side-side gastrogastrostomy performed to straighten the alpha-loop. The patient tolerated food better and with overnight PEG tube feeds gained weight but continued heavy smoking. He died after one year from COPD exacerbation. Conclusion LLG seems to be an appropriate intervention for various gastric pathologies. Training of residents and fellows in the minimally invasive surgical steps of LLG is encouraged.
Highlights
Sleeve gastrectomy has emerged as the most commonly performed bariatric procedure during the past decade [1, 2].e sleeve, vertical, lateral, or longitudinal gastrectomy is a bariatric procedure but was suggested to treat duodenogastric biliary reflux as part of the duodenal switch operation [3,4,5,6]. e first series were performed using laparotomy, but soon, the laparoscopic approach was adopted to treat morbid obesity [4]
longitudinal gastrectomy (LLG) was considered in all cases during preoperative planning and was discussed with patients; in all cases, decision for LLG was made during surgery after contemplating other surgical options
A large blood vessel originating from the splenic artery was clipped (Figure 1(b)), and a LLG was performed. e clipped Dieulafoy lesion was identified in the specimen (Figure 1(c)). e patient had an uneventful postoperative course, her BMI decreased to 26 kg/m2, but she was noncompliant with follow-up and refused to come to office visits
Summary
Sleeve gastrectomy is the most commonly performed bariatric procedure. Laparoscopic longitudinal gastrectomy (LLG) may be indicated for other indications. Two men and two women aged 67, 72, 77, and 80 years underwent LLG for nonbariatric indications with two having normal weight, one being cachectic, and one severely obese. E patient tolerated food better and with overnight PEG tube feeds gained weight but continued heavy smoking. E last patient developed dysphagia due to an alphaloop in the sleeve, which was managed by endoscopic stenting. He died after one year from COPD exacerbation. Training of residents and fellows in the minimally invasive surgical steps of LLG is encouraged
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