Concomitant Laparoscopic Sleeve Gastrectomy Research Articles

Case Report: Acute Intrathoracic Sleeve Migration with Partial Volvulus after Laparoscopic Sleeve Gastrectomy and Hiatal Hernia Repair

Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure in the United States and is widely accepted due to its technical ease and effectiveness. Concomitant hiatal hernia repair, if detected during an LSG, is recommended. Intrathoracic sleeve migration (ITSM), a sliding hiatal hernia that develops after LSG, is a rare complication of this procedure. This report presents an early case of ITSM due to intermittent retching, resulting in postoperative incarceration of the proximal sleeve. The patient is a 28-year-old female who underwent concomitant LSG and hiatal hernia repair and was readmitted for acute entrapment of the proximal portion of the sleeve. The patient underwent re-operation with reduction of the proximal sleeve, and omentopexy was performed for stabilization. Intraoperative esophagogastroduodenoscopy was performed to ensure the detorsion and patency of the sleeve before the surgery. No additional hiatal hernia repair was attempted. ITSM with incarceration is an interesting phenomenon that is underrecognized and underreported. It can present postoperatively with reflux symptoms and poor oral tolerance. Failure to make an accurate diagnosis and intervene can result in prolonged hospitalization and poor patient outcomes.

Hill Modified, a Novel Approach: Technique Description and Experience in Patients with Laparoscopic Sleeve Gastrectomy.

Gastroesophageal reflux disease (GERD) is a common disease among patients with obesity, with an associated prevalence of 39 to 61% between the population who attends a bariatric surgery evaluation. Laparoscopic sleeve gastrectomy (LSG) has become a popular and valid option for obesity treatment, even though the literature is ambivalent regarding the increase or decrease in GERD after this surgery. Thus, it is necessary to propose new surgical techniques as a solution to GERD in patients with a concomitant LSG or with a history of it. Therefore, we present a modified technique based on Hill's gastropexy described originally in 1967. Describe and propose a surgical procedure for GERD management based on the Hill technique that can be applied in all patients who undergo an LSG or with a history of it. Retrospective observational study with a prospective database in which we described, Hill modified technique in a group of 16 patients with GERD who underwent this procedure concomitantly with an LSG or who presented with GERD after LSG with a 3-year follow-up. The surgical technique is based on an intra-abdominal esophageal length of a minimum of 3 cm and posterior fixation of the gastroesophageal junction to the crus. Postoperative controls have shown satisfactory results in the control and management of GERD symptoms in this group of patients, with very few to no complications associated with the procedure and without reintervention or medication out of the standard protocol. Hill modified technique can be used and presented as an option for GERD control in patients with LSG.

Gastroesophageal reflux disease complicating laparoscopic sleeve gastrectomy: current knowledge and surgical therapies.

Laparoscopic sleeve gastrectomy (LSG) is currently the most commonly performed bariatric procedure worldwide. However, the incidence of gastroesophageal reflux disease (GERD) after LSG is high. The aim of this systematic review was to identify the optimal surgical strategy for treating GERD after LSG. West China Hospital, Sichuan University, Chengdu, China. A systematic literature search was performed to identify studies on surgical treatments for GERD after LSG. The effectiveness and safety profile of surgical management on GERD after LSG were analyzed. A total of 40 articles enrolling 2049 patients were included in this review. Surgical strategies to prevent GERD after LSG were mainly of 2 types: concomitant LSG + antireflux procedures (hiatal hernia repair or fundoplication) and secondary procedures (conversion to Roux-en-Y gastric bypass [RYGB] or repeat sleeve gastrectomy). The short-term remission or improvement rate of GERD was 34.6%-100% after concomitant LSG + antireflux procedures. The postoperative complication rate was the same (3.0%) for both LSG + antireflux procedures and LSG alone. The remission or improvement rate of GERD was 57.1%-100% after conversion to RYGB and 100% after repeat sleeve gastrectomy. The effectiveness and safety profile of concomitant LSG + antireflux procedures is uncertain. However, secondary operations after LSG, such as conversion to RYGB, appear to provide good results. The data overall are heterogeneous, with imprecise methods of documenting anddefining GERD complicating LSG. More cohort studies or RCT studies of high quality with long-term follow-up are needed in the future.

Routine Upper Gastrointestinal Fluoroscopy Before Laparoscopic Sleeve Gastrectomy: Is It Necessary?

Controversy exists regarding the clinical utility of routine preoperative upper gastrointestinal (GI) fluoroscopy in morbid obese patients undergoing laparoscopic sleeve gastrectomy (LSG). The aim of our study was to determine the efficacy of these studies in detecting hiatal hernias (HH). The institution's prospectively maintained, IRB-approved database was retrospectively queried to identify all consecutive patients who underwent LSG between 2011 and 2017. All patients underwent routine preoperative upper GI fluoroscopy. Reports from all imaging studies were retrospectively reviewed and compared to the presence of an intraoperative HH. During the study period, a total of 1810 patients (854 males, 956 females) underwent LSG at our institution. Mean age was 40.95 ± 13years (range 11-75), and mean BMI was 42.8 ± 5kg/m2 (range 30-86). The overall prevalence of HH was 11.1% (201 patients). All HHs detected were repaired. Considering the intraoperative identification of HH the gold standard for diagnosis, the sensitivity and specificity of preoperative UGI fluoroscopy for HH detection were 32% (66/201) and 94% (1512/1609), respectively. The median operative time was significantly longer when concomitant LSG and HH repair was performed compared to LSG alone (76min vs. 55min, p < 0.001, respectively). The foreknowledge of HH had no influence on the median operative times (77min vs. 75min, predicted vs. incidental, respectively, p = 1.34). HH repair did not affect the complication rate (p = 0.3). Routine preoperative upper GI fluoroscopy holds a low sensitivity for HH detection. Health policy regulators should consider omitting this exam from routine preoperative evaluation for bariatric patients.

Does concomitant laparoscopic sleeve gastrectomy and hiatal hernia repair increase morbidity?

IntroductionObesity not only leads to susceptibility to gastroesophageal reflux disease but also is itself an important independent risk factor for the development of hiatal hernia. A coexisting hiatal hernia is found in half of obese patients with gastroesophageal reflux disease symptoms. Sleeve gastrectomy is the most commonly used restrictive method in obesity surgery. In obese patients who are scheduled to undergo sleeve gastrectomy (SG) and have a hiatal hernia, hiatal hernia repair (HHR) can be combined with SG.Material and methodsPatients who underwent SG due to morbid obesity were retrospectively evaluated. Patients who had a body mass index of &gt; 40 kg/m² and who were diagnosed with hiatal hernia by preoperative endoscopy or intraoperatively were included in the study.ResultsA total of 30 patients who underwent SG and hiatal hernia repair were included in the study. Six patients were diagnosed with hiatal hernia by preoperative endoscopy. Twenty-four patients were intraoperatively diagnosed with hiatal hernia. The hiatal defect was repaired by suturing both anteriorly and posteriorly. There were no intraoperative or postoperative complications in any patient. The mean hospital length of stay was 3.46 days (range: 3–6). The mean follow-up time was 11.9 months (range: 4–21). Thirteen patients received medication due to acid reflux symptoms in the preoperative period. Twelve patients received no medication after surgery. One patient received low-dose medication.ConclusionsIn bariatric surgery patients with hiatal hernia, HHR should also be performed. Sleeve gastrectomy + HHR is a safe and effective method for morbidly obese patients with hiatal hernia.

Is concomitant cholecystectomy with laparoscopic sleeve gastrectomy safe?

To study the effect of selective concomitant cholecystectomy (SCC) on laparoscopic sleeve gastrectomy (LSG). A retrospective case-control study of 16 morbidly obese patients treated with concomitant LSG as the primary bariatric surgery and SCC for proven gallbladder (GB) pathology (Group A) between November 2010 and February 2013 was performed. Randomly selected 32 patients who underwent laparoscopic sleeve gastrectomy was the control group (Group B). A total of 48 patients with a mean age of 35.5±10.7 years were included. Demographic data of groups were similar except that there were more female patients in the Group A (p=0.036). Mean body mass index (kg/m2) was 51.1±5.6 and 50.9±5.4 in Groups A and B, respectively (p=0.894). The mean operative time for patients with and without cholecystectomy was 157.2±40 and 95.72±6.2 min, respectively (p=0.001). Cholecystectomy resulted in an additional mean operative time of 49.1±27.9 min without any specific complication. There was no statistical difference with regard to overall morbidity (p=0.316) and the length of hospital stay (p=0.528) between groups. Although an increase in operative time may be an important issue, SCC can be performed on all patients with proven GB pathology during LSG without an increase in morbidity or length of hospital stay.

Laparoscopic Removal of Poor Outcome Gastric Banding with Concomitant Sleeve Gastrectomy

Laparoscopic adjustable gastric banding (LAGB) has a significant incidence of long-term failure, which may require an alternative revisional bariatric procedure to remediate. Unfortunately, there is few data pinpointing which specific revisional procedure most effectively addresses failed gastric banding. Recently, it has been observed that laparoscopic sleeve gastrectomy (LSG) is a promising primary bariatric procedure; however, its use as a revisional procedure has been limited. This study aims to evaluate the safety and efficacy of LSG performed concomitantly with removal of a poor-outcome LAGB. A retrospective review was performed on patients who underwent LAGB removal with concomitant LSG at King Saud University in Saudi Arabia between September 2007 and April 2012. Patient body mass index (BMI), percentage of excess weight loss (%EWL), duration of operation, length of hospital stay, complications after LSG, and indications for revisional surgery were all reviewed and compared to those of patients who underwent LSG as a primary procedure. Fifty-six patients (70% female) underwent conversion of LAGB to LSG concomitantly, and 128 (66% female) patients underwent primary LSG surgery. The revisional and primary LSG patients had similar preoperative ages (mean age 33.5 ± 10.7 vs. 33.6 ± 9.0years, respectively; p = 0.43). However, revisional patients had a significantly lower BMI at the time of surgery (44.4 ± 7.0kg/m(2) vs. 47.9 ± 8.2; p < 0.01). Absolute BMI postoperative reduction at 24months was 14.33 points in the revision group and 18.98 points in the primary LSG group; similar %EWL was achieved by both groups at 24months postoperatively (80.1 vs. 84.6%). Complications appeared in two (5.5%) revisional patients and in nine (7.0%) primary LSG patients. No mortalities occurred in either group. Conversion of LAGB by means of concomitant LSG is a safe and efficient procedure and achieves similar outcomes as primary LSG surgery alone.