What to Do When It Is Technically Impossible to Perform Laparoscopic Sleeve Gastrectomy View Full Text


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Article Info

DATE

2014-06-22

AUTHORS

Lionel Rebibo, Abdennaceur Dhahri, Pierre Verhaeghe, Jean-Marc Regimbeau

ABSTRACT

BackgroundLaparoscopic sleeve gastrectomy (LSG) is increasingly popular with surgeons because of its apparent technical ease. However, performing LSG safely is sometimes not possible during laparoscopy. The objectives of the present study were to (i) describe the context of LSG failure and (ii) suggest preoperative care options or strategies that enable secondary LSG to be performed safely.MethodsWe studied patients having undergone primary and secondary LSG between January 2008 and July 2013. The primary efficacy criterion was the LSG success rate. The secondary efficacy criteria were preoperative care procedures, the complication rate, the failure rate, and the frequency of conversion to open surgery.ResultsDuring the study period, 954 patients underwent first- or second-line LSG. Laparoscopic sleeve gastrectomy was technically impossible in 12 patients (1.2 %). The cause of failure was a large left liver lobe in seven cases (58.3 %) and a lack of space in five cases. Of these 12 patients, nine underwent secondary LSG. The median preoperative BMI before the first LSG was 51.5 kg/m2. The median (range) time interval between the two LSG attempts was 6 months (3–37). Prior to secondary LSG, the preoperative weight reduction measure was a diet in seven cases (78 %), an intragastric balloon in one case, and no treatment in one case. The median preoperative excess weight loss (EWL) before the second LSG was 10 % (0–20). Five LSGs were successful, two required conversion to open surgery, and two failed again. There were two postoperative complications (22 %), both of which concerned the two patients with conversion to laparotomy.ConclusionsIn the event of LSG technical failure, preoperative weight loss may enable a second attempt at laparoscopic treatment. A preoperative EWL of at least 10 % appears to be required for the avoidance of conversion to laparotomy. More... »

PAGES

2069-2074

References to SciGraph publications

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  • 2013-12-19. Laparoscopic Gastric Bypass vs. Sleeve Gastrectomy in the Super Obese Patient: Early Outcomes of an Observational Study in OBESITY SURGERY
  • 2012-07-12. Simultaneous Gastric Band Removal and Sleeve Gastrectomy: a Comparison with Front-Line Sleeve Gastrectomy in OBESITY SURGERY
  • 2004-10-01. Preoperative Low Energy Diet Diminishes Liver Size in OBESITY SURGERY
  • 2006-09-01. Effectiveness of Laparoscopic Sleeve Gastrectomy (First Stage of Biliopancreatic Diversion with Duodenal Switch) on Co-Morbidities in Super-Obese High-Risk Patients in OBESITY SURGERY
  • 2013-03-05. The Intra-gastric Balloon for Pre-operative Weight Loss in Bariatric Surgery: Is it Worthwhile? in OBESITY SURGERY
  • 2004-10-01. Factors Determining Conversion from Laparoscopic to Open Roux-en-Y Gastric Bypass in OBESITY SURGERY
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    http://scigraph.springernature.com/pub.10.1007/s11695-014-1320-0

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    http://dx.doi.org/10.1007/s11695-014-1320-0

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1026415030

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/24952633


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