Vasileios Drakopoulos, MD, PhD, FACS1, Athanasios Bakalis, MD1, Nikolaos Roukounakis, MD, PhD1, Sotirios Voulgaris, MD1, Sotiria Tsogka, MD2, Eleni Plesia, MD, PhD2, Spiros Drakopoulos1. 1First Department of Surgery and Transplant Unit, Evangelismos General Hospital, Athens, Greece, 2Department of Anaesthesiology, Evangelismos General Hospital, Athens, Greece
Background. Sleeve gastrectomy is traditionally performed with the aid of 5 to 7 abdominal trocars. By reducing the number of trocars, parietal trauma, pain and hernia risks can be minimized. We present our early experience concerning laparoscopic sleeve gastrectomy for morbid obesity, with a more minimal invasive approach, using three port- trocars.
Methods. Fifteen cases of sleeve gastrectomy for morbid obesity were retrospectively analysed, in terms of trocar placement and postoperative outcomes. The typical position of the trocars included one periumbilical of 10mm for a camera of 30o, and another two trocars of 12mm on the right and left midclavicular lines, respectively. The procedure includes percutaneous insertion of a stitch under direct laparoscopic vision which is fixed to the right crus of the diaphragm. Carefull traction of the stitch lifts the left lobe of the liver offering better surgical field and access to the gastroesophageal junction without any liver retractor. A gauze is used to protect liver parenchyma from possible injury. All patients are followed-up every six months for evaluating weight loss and quality of life.
Results. All the patients had an uncomplicated recovery. No liver injury or wound problem was mentioned.
Conclusions. The placement of a stitch at the right crus of the diaphragm can reduce the number of trocars, leading to less postoperative pain, risk of hernia and better aesthetic outcome without compromising the safety of the operation, or the rate of postoperative complications.
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