Ali Fardoun, MD
Emirates International Hospital,Al-Ain,UAE
Introduction: With short time the Gastric sleeve is considered the most popular procedure done in the world. The technique is standardized with slight modifications regarding the size of the calibration tube and the distance from the pylorus . Also the distance from GE junction has created a discrepancy between surgeons . The theory of the ghrelin hormone responsible of the hunger feeling and located in the fundus has many defensors among Bariatric Surgeons being mandatory to resect that part.
Method: I did 85 cases till now of this technique. Having experience in Gastric Plication (LGCP) I found useful to avoid cutting the antrum and conserve the innervations of this vital part of the stomach. It was easy to start reducing the antrum just near the pylorus ( at 2 cm). By the use of 2/0 Prolene needle 26 round tip , I start to give an interrupted seromuscular stitches till 2 cm over the incisura which is more than the third part of the stomach. This is done using same calibration tube 36 F of the sleeve . I start stapling from that point up to the GE junction which takes 3 reloads of 60 mm in most cases . Reinforcement of the suture line is optional .
Results: With this technique I found an important improvement and drop in nausea and vomiting symptoms with better evacuating function of the stomach. The size of the stomach decreased being more restrictive and with less residual volume. There was no difference of EWL between the normal sleeve and this procedure.
Conclusion: more studies are needed to understand the function of the stomach after using this technique where partial reversibility is a fact if we need to increase the volume of the stomach for any reason . Less leak and bleeding in half lower part of the stomach is guaranteed while we don’t know if it will increase incidence of leak in the upper part because of reducing the size of the antrum .
Program Number: P004