Endo-Laparoscopic Sleeve Gastrectomy for Treatment of Morbid Obesity

Dennis Wong, MD, Wai-Hong Chan, MD, Ho-Hing Wong, Michael Li, MD. Pamela Youde Nethersole Eastern Hospital

Introduction: The aim of this study was to evaluate the result of a novel minimally invasive surgical technique that combines conventional laparoscopic sleeve gastrectomy with endoscopy in the management of morbid obesity.
Method: Patients who fulfilled the recommendation for bariatric surgery (according to the Asia Pacific Bariatric Surgery Group Consensus) were included in this study. Conventional laparoscopic sleeve gastrectomy was performed with the exception of using a standard colonoscope (Fr 39) instead of bougie. The endoscope served several purposes: 1) for gastric tube calibration, 2) for intraoperative assessment of intraluminal staple line haemorrhage and staple line integrity by performing air leak test. The endpoints of this study were to assess for staple line bleeding, leakage and stenosis.
Results: From 2007 to 2010, twenty morbidly obese patients underwent this endo-laparoscopic sleeve gastrectomy. Of these patients with a mean age of 37, ten were male. Their mean initial body weight was 124kg (Body mass index 44kg/m²). Mean percentage excessive weight loss achieved at 2 years was 61%. There was no intraluminal staple bleeding on endoscopy that required intervention. Two patients had staple line air leak just below oesophago-gastric junction that required overrunning sutures. None of the patients experienced delayed staple line leakage or stenosis. There was no mortality during this study.
Conclusion: This combined endo-laparoscopic technique is safe and feasible, and may reduce the potentially fatal complication of staple line leakage.