Laparoscopic sleeve gastrectomy using the LiVac liver retractor system: technical report.
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SUBMITTER: Park D
PROVIDER: S-EPMC8255578 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:There is a paucity of data regarding gastritis as a technical factor affecting the surgical technique. Antritis and gastritis usually cause stomach wall thickness which can interrupt stapler function or even can cause serosal tear during the dissection. We report a video presentation of laparoscopic sleeve gastrectomy in a morbidly obese patient with antritis. Choosing black cartridge for patients with Helicobacter pylori gastritis might be the optimal technique for division of the antrum in laparoscopic sleeve gastrectomy. Further studies are required to clarify this parameter.
| S-EPMC6057504 | biostudies-literature
Project description:Obesity and its related comorbidities is a major health problem worldwide. Sleeve gastrectomy is regarded to be one of the most effective bariatric surgeries with a relatively low risks of complications. Gastrobronchial fistula is an extremely rare and a serious complication after bariatric surgeries, it is associated with major morbidity. A 48-year-old obese lady with a BMI of 40 had underwent laparoscopic sleeve gastrectomy 7 years ago, she developed leak at the 10th postoperative day which was treated with drainage. After 4 years she presented with left subphrenic abscess which was treated with drainage, splenectomy and endoscopic stent. After one year she had repeated chest infections and was coughing-up recently ingested food items. CT-scan showed left subphrenic collection with abnormal fistulous tract between the bronchial tree and the subphrenic cavity. Left thoracotomy was performed, a complex fistula was found between the remnant parts of the gastric fundus, transverse colon and lung. Resection of the fistula was performed, the stomach and colon were closed in 2 layers, resection of the affected segment of lung was performed and the diaphragm was sutured. The BMI was 19 at the last admission. Gastro-colo-bronchial fistula is unreported after sleeve gastrectomy and the management is challenging. Surgeons may follow the same principles of management as in cases of gastrobronchial fistula, but we suggest earlier surgical intervention with the administration of broad spectrum antibiotics. Nutritional deficiencies must be corrected, and such patients must be treated with multidisciplinary team, with an extended duration of follow-up.
| S-EPMC7272498 | biostudies-literature
Project description:INTRODUCTION:This is a case report that presents an unusual case of Polysplenia Syndrome (PSP) undergoing laparoscopic sleeve gastrectomy (LSG). This kind of presentation would be of interest to general surgeons who perform bariatric surgery. PRESENTATION OF CASE:The case presented is a 28-year-old female patient who was not a known case of Polysplenia Syndrome. During the patients' pre-operative assessment, physical examination was done and a type of heterotaxy syndrome was suspected upon palpation of the stomach. Therefore, Computed Tomography (CT) imaging was performed which confirmed PSP. She underwent laparoscopic sleeve gastrectomy due to her morbid obesity, as her Body Mass Index (BMI) was 40.8 kg/m2. Post-operatively, water soluble contrast study was performed to rule out leak and the patient had uneventful follow-up. DISCUSSION AND CONCLUSION:The surgical approach of such patients is somewhat similar to those with situs solitus; however, the performing surgeon must take into consideration the anatomical orientation. Proper assessment of such patients prior to surgery with history, full physical examination, and fitting imaging modalities is essential.
| S-EPMC7530230 | biostudies-literature
Project description:BACKGROUND:Laparoscopic sleeve gastrectomy (LSG) modifies the upper gastrointestinal tract motility. Controversial data currently exist. The aim of the study was to evaluate esophageal motility before and after LSG. PATIENTS AND METHODS:Morbid obese patients scheduled for LSG underwent reflux symptoms evaluation and manometry preoperatively and postoperatively. The preoperative and postoperative results were compared and analyzed. RESULTS:Eighteen patients were enrolled. Heartburn and regurgitation improved in 38.9% and 11.1% of the patients, but deteriorated in 11.1% and 27.8% of the patients, respectively. Lower esophageal sphincter (LES) total length decreased postoperatively (p=0.002). Resting and residual pressures tended to decrease postoperatively (mean difference [95% confidence interval]: -4 [-8.3/0.2] mmHg, p=0.060; -1.4 [-3/0.1] mmHg, p=0.071, respectively). Amplitude pressure decreased from 95.7±37.3 to 69.8±26.3 mmHg at the upper border of LES (p=0.014), and tended to decrease at the distal esophagus from 128.5±30.1 to 112.1±35.4 mmHg (p=0.06) and mid-esophagus from 72.7±34.5 to 49.4±16.7 mmHg (p=0.006). Peristaltic normal swallow percentage increased from 47.2±36.8 to 82.8±28% (p=0.003). Postoperative regurgitation was strongly negatively correlated with LES total length (Spearman's r=-0.670). When groups were compared according to heartburn status, statistical significance was observed between the groups of improvement and deterioration regarding postoperative residual pressure and postoperative relaxation (p<0.002, p<0.002, respectively). With regard to regurgitation status, there was statistically significant difference between groups regarding preoperative amplitude pressure at the upper border of LES (p<0.056). CONCLUSION:Patients developed decreased LES length and weakened LES pressure after LSG. Esophageal body peristalsis was also affected in terms of decreased amplitude pressure, especially at the upper border of LES. Nevertheless, body peristalsis was normalized postoperatively. LSG might not deteriorate heartburn. Regurgitation might increase following LSG due to shortening of LES length, particularly in patients with range of preoperative amplitude pressure at the upper border of LES of 38.9-92.6 mmHg.
| S-EPMC5529110 | biostudies-literature
Project description:IntroductionManagement of severe reflux after sleeve gastrectomy (SG) usually requires converting to Roux-en-y gastric bypass (RYGB). We present a case of managing this problem using the LINX® system.Presentation of caseIn February 2015, we performed a laparoscopic placement of LINX® system to treat severe reflux after sleeve gastrectomy on a 25-year-old female. The operative time was 47min. There were no intra or postoperative complications. The hospital stay was one day. The postoperative UGI showed no reflux. Ten days after surgery her Quality of life score (QOL) changed from 64/75 to 7/75 after the LINX® placement. One year later the patient continued to enjoy no reflux and stayed off medication.DiscussionReflux after sleeve gastrectomy is usually managed by conversion to RYGB by most surgeons. This case report opens the door for an alternative management of this problem while maintaining the original sleeve gastrectomy. This technique is reasonably easy to perform in comparison to the conversion to RYGB with less potential post-operative complications. A one year follow up showed good control of reflux without medication.ConclusionLaparoscopic placement of the LINX® system to correct severe reflux after sleeve gastrectomy is a safe alternative procedure to conversion to a RYGB.
| S-EPMC5192038 | biostudies-literature
Project description:Laparoscopic sleeve gastrectomy is currently a stand-alone bariatric procedure with a low complication profile. A rare complication of leak following sleeve gastrectomy was reported in this study. Its rareness and nonspecific clinical presentation could make the diagnosis difficult and could be easily confused with leak and subdiaphragmatic abscess. A 22-year-old Saudi female with body mass index 41 underwent laparoscopic sleeve gastrectomy in 2017, presented 18 months later to emergency department complaining of fever and abdominal pain for 3 months prior to presentation. Computed tomography of abdomen revealed a large splenic abscess, upper gastrointestinal studies were unremarkable. Patient was taken for laparoscopic exploration with finding of splenic abscess and gastric fistula, splenectomy and clipping of fistula was performed. The management of splenic abscess remains controversial. Splenectomy and antibiotics have generally been the definitive treatment particularly with large multilobulated collection. Familiarity with the rare complications as splenic abscess will allow for a prompt diagnosis and treatment.
| S-EPMC8084437 | biostudies-literature
Project description:IntroductionBariatric surgery has shown to produce the most predictable and tangible results for weight loss, with laparoscopic sleeve gastrectomy's being the most popular one of them. However, the occurrence of previously undiagnosed diseases can be encountered during bariatric operations. The work has been reported in line with the SCARE criteria.Case presentationThis is the case of a 54year old morbidly obese female, presenting to our hospital for a laparoscopic sleeve gastrectomy. During her procedure, it was discovered that she has an accessory spleen on the fundus of her stomach. The decision was made to resect it with the specimen of the stomach for histopathalogical examination.ConclusionIncidental findings during routine bariatric surgery are a common occurance, and therefore prompt and effective intra-op management is key to the prognosis of the patient. Accessory spleens, although uncommon, tend to be asymptomatic. However, if undiagnosed, could present with dangerous consequences.
| S-EPMC5447567 | biostudies-literature
Project description:Laparoscopic sleeve gastrectomy (LSG) is an important therapeutic option for morbidly obese patients. Although LSG promotes sufficient weight loss, how LSG changes plasma metabolites remains unclear. We assessed changes in plasma metabolite levels after LSG. We collected plasma samples from 15 morbidly obese Japanese patients before and 3 months after LSG. A total of 48 metabolites were quantified using capillary electrophoresis time-of-flight mass spectrometry-based metabolomic profiling. Branched chain amino acids, several essential amino acids, choline, 2-hydroxybutyric acid, 2-oxoisovaleric acid and hypoxanthine were significantly decreased after LSG. Tricarboxylic acid cycle metabolites, including citric acid, succinic acid and malic acid, were significantly elevated after LSG. This is the first report to show dynamic alterations in plasma metabolite concentrations, as assessed using capillary electrophoresis time-of-flight mass spectrometry, in morbidly obese patients after LSG. Our results might show how LSG helps improve obesity, in part through metabolic status changes, and propose novel therapeutic targets to ameliorate obesity.
| S-EPMC7779268 | biostudies-literature
Project description:Introduction:Single-incision laparoscopic surgery (SILS) has benefits, including less postoperative pain, a shorter incision, and improved cosmesis. However, SILS is technically difficult because of the limited movement. An organ retractor is an instrument that has the potential to overcome these limitations. Presentation of case:An 85-year-old woman with hematochezia was referred to our hospital. Emergency endoscopy showed diverticulosis of the entire colon and active bleeding from the ascending colon. Despite endoscopic clipping, the bleeding continued. SILS total colectomy using an organ retractor was performed due to uncontrollable diverticular bleeding. A 3-cm incision was placed in the umbilicus, and three conventional ports were inserted into the single umbilical incision. An organ retractor was used for hepatocolic ligament transection, transection of the ileocolic vessels, and transection of the mesentery of the sigmoid colon. For each transection, the tension was adjusted to provide a good operative view. The patient's postoperative course was uneventful. Conclusion:An organ retractor was effective for SILS total colectomy to maintain an adequate operative view, which enabled safe dissection.
| S-EPMC7248583 | biostudies-literature
Project description:Introduction& Importance: Laparoscopic sleeve gastrectomy (LSG) is a widely accepted and effective bariatric surgery for achieving weight loss in patients with extreme obesity. Performing this surgical procedure in patients with congenital anatomical changes including situs inversus (SI) is a challenge for the surgical team. In this condition, the orientation of intra-abdominal organs is the mirror image of those in normal populations.Case presentationHerein, we present a 29-year-old female with situs inversus totalis who successfully underwent an LSG surgery with proper weight loss post-operatively and no early and late complications.Clinical discussionBy reviewing the literature for patients with SI undergoing the same procedure, all patients achieved significant weight loss. Three out of nineteen cases experienced complications which were controlled without significant morbidity or mortality.Conclusion: we concluded that LSG will be a safe and effective surgery for the treatment of extreme obesity in SI patients, if the condition is diagnosed preoperatively.
| S-EPMC9289484 | biostudies-literature