Bariatric surgery laparoscopic sleeve gastrectomy
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Bariatric surgery Laparoscopic Sleeve Gastrectomy PowerPoint PPT Presentation


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Bariatric surgery Laparoscopic Sleeve Gastrectomy. By Dr Hosam Ghazy El-Banna Assistant Professor of General surgery Mansoura Faculty of Medicine. Introduction.

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Bariatric surgery Laparoscopic Sleeve Gastrectomy

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Bariatric surgeryLaparoscopic Sleeve Gastrectomy

By

Dr Hosam Ghazy El-Banna

Assistant Professor of General surgery

Mansoura Faculty of Medicine


Introduction

  • Laparoscopic Sleeve gastrectomy (LSG) is a new restrictive bariatric procedure increasingly indicated in the treatment of morbid obesity.

  • LSG is a reproducible and seems to be an effective treatment to achieve significant weight loss after 12 months follow-up.


Indications

  • LSG was indicated for weight reduction only for patients with a BMI > 40 or > 35 kg/m2 with severe comorbidity.

  • Patients assessed by a dietician, a nutritionist, and a psychologist before surgery.


Preoperative preparation

  • Start Atkins diet for 2 weeks before the surgery to reduce the fat around your liver.

  • Make sure to be on a regular intake of clear fluids 48 hours before surgery.

  • Stop any medication unless indicated and recommended by your doctor.


Operative procedure

  • Operations are performed under general anesthesia using the supine position.

  • Each procedure required only 4 trocars.

  • Two 12-mm ports were placed in the supraumbilical region and in the left upper quadrant.

  • One 10-mm port was placed in the right upper quadrant for liver retraction.

  • One 12-mm port used for stapling was placed in the left mid-abdomen, just medial to the mid-clavicular line .


Placement of 4 trocars


  • Pneumoperitoneum was induced by primary trocar insertion and maintained at a pressure of 16 mm Hg.

  • Dissection began on the greater curvature, 6 cm from the pylorus.

  • The gastrocolic ligament along the greater curvature of the stomach was opened using a coagulator and was freed as far as the cardioesophageal junction.

  • A 36-F plastic tube was then inserted perorally into the stomach by the anesthesiologist and was directed toward the pylorus.


  • A laparoscopic linear stapler was introduced into the peritoneal cavity and was positioned so that it divided the stomach parallel to the orogastric tube along the lesser curvature.

  • The instrument was fired, reloaded, and the maneuver was repeated; 60-mm green cartridge was used to staple the antrum followed by 3 or 4 sequential 60-mm gold cartridges to staple the remaining gastric corpus and fundus.

  • After 5 or 6 firings of the stapler, the greater curvature was completely detached from the stomach.


  • A methylene blue test was performed to exclude staple-line leakage.

  • The gastric suture line was not systematically reinforced except in the case of bleeding or positive methylene blue test, in which case a drain was placed along the staple line.


  • A nasogastric tube was left in place.

  • A water-soluble upper gastrointestinal (GI) contrast study was performed on the first postoperative day, and oral fluids were allowed if no leakage was demonstrated.

  • Patients were discharged except in the case of a complication resulting in prolongation of the hospital stay.


Follow up

  • Patients were reviewed at 1 month and then every 3 months.

  • Mortality and morbidity were defined as death or complications and reoperations during the first 30 days after the operation or during the hospital stay, respectively.


Eating after surgery

  • Immediately after surgery, the patient is restricted to a clear liquid diet.

  • The next stage provides a blended or pureed sugar-free diet for at least two weeks.

  • Post-surgery, overeating is curbed because exceeding the capacity of the stomach causes nausea and vomiting.


Advantages

  • Stomach tends to function normally so most food items can be consumed in small amounts.

  • Removes the portion of the stomach that produces the hormones that stimulates hunger (Ghrelin).

  • No dumping syndrome because the pylorus is preserved.

  • Minimizes the chance of an ulcer occurring.

  • The chance of intestinal obstruction, anemia, osteoporosis, protein deficiency and vitamin deficiency are significantly reduced.

  • Results appear promising as a single stage procedure for low BMI patients (BMI 35–45 kg/m2).


Complications

  • Leakage: can be treated easily by performing a second procedure that helps in strengthening the staple lines.

  • Stapple line bleeding:

  • Gastroesophageal Reflux: It might be happening because of the changes in the shape of the stomach.

  • Gastric Fistula: may occur and another surgery may be needed to treat this condition.


  • Narrowing of Stoma: A tube used for dilation is passed from the mouth to pass into the stomach as this expands the stoma.

  • Hernia: Another surgery may be needed to repair this condition.

  • Malabsorption of Vitamins and Minerals:

    • Anemia and vitamin B12 deficiency can cause neurological diseases.

    • Changes in the absorption of phosphates, calcium and oxalates can result in kidney stone formation.

    • Similarly, deficiency of vitamin D and calcium can also give rise to different disorders of the bone.


  • Microbial infections : as pneumonia and intraabdominal abscess are most common.

  • Deep vein thrombosis (DVT).

  • Hair loss.

  • Hair thinning.

  • Mood swings.

  • General feeling of weakness.

  • Dry skin .


Outcomes of SG & other bariatric procedures


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