Ivan Strachan, MD, Gianna Ramos, MD
Centro Internacional de Cirugia avanzada
The sleeve gastrectomy has become one of the most frequent technique in the treatment of obesity. The risk of fistula and its management is one of the most feared complication The high rate of gastroesophageal reflux and hiatal hernia lead many surgeons to prefer the gastric-bypass.
Hypothesis: The variant we are suggesting will reduce significantly the incidence of postoperative fistula and reflux disease.
Material and methods:
Our descriptive study included 200 patients The technique was performed in all of them The patients were selected base on the standards’ criteria for bariatric surgery
- Understand the criteria used for selection.
- Evaluate the distribution by age, sex and body mass index.
- Identify the complications and their management
- Evaluate the effectiveness of the procedure
Our technique starts with a thorough and systematic dissection of the esophageal hiatus and gastric fundus. The sleeve is created by resecting the greater curvature of the stomach using endoscopic gastrointestinal mechanical stapler ECHELON – FLEX 60 (Johnson & Johnson), starting 4 cm from the pylorus over a 36 Fr bougie, keeping the same diameter throughout its length. This is follow by reinforcement of the staple line with a running suture The proximal 3 to 4 cm are sutured to the right side of the esophageal hiatus. In patients with esophagitis and hiatal hernia the technique is complemented with hiatoplasty
In our cohort 200 patients underwent the procedure from November 2010 to June 2012. One hundred and twenty two patients were female and 78 male. The mean age was 37 years old and BMI of 41. Gastroduodenal barium series were performed preoperatively, one month and three months after surgery. No bleeding complications were observed . The episodes of reflux were resolved or improved in all patients. No hiatal hernia was reported. One patient developed suture line leak postoperatively
We believe our modification to the sleeve gastrectomy is an acceptable option to improve its outcome by reducing its postoperative complications and incidence of gastroesophageal reflux.
Session: Poster Presentation
Program Number: P418