Bariatric Times

Sleeve Gastrectomy 2015

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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A16 Bariatric Times • April 2015 • Supplement A 5 th INTERNATIONAL CONSENSUS SUMMIT FOR SLEEVE GASTRECTOMY (6.8–13.6%). The types of diabetes treatment in the group were lifestyle modification in one patient, oral agents (OA) in 13 patients, insulin in 11 patients, and a combination of OA/insulin in 12 patients. The average duration of diabetes was 8.7±6.2 years (0–21 years). SURGICAL TECHNIQUE During the live surgery session at the 5th International Consensus Summit for Sleeve Gastrectomy, we performed LSG-DJB in Tokyo, Japan. The procedure was transmitted live to the audience in Montreal, QC, Canada. After establishing pneumoperitoneum at 15mmHg, five laparoscopic ports are placed in the upper abdomen. The short gastric vessels on the greater curvature of the stomach are divided using an ultrasonic energy device from a distance 4cm proximal to the pylorus up to the gastroesophageal junction. Complete mobilization of the fundus with exposure of the left crus and dissection of the posterior wall of the stomach from the pancreas are routinely obtained. The 37.5 Fr. calibration tube s pecially designed for sleeve gastrectomy (Midsleeve ™ , Medical Innovation Developpement [MID], Dardilly, France) is advanced transorally along the lesser c urvature into the pyloric channel. We proceed with dividing the stomach using a 60mm endoscopic linear stapler (Endo GIA ™ Reinforced Reload with Tri-Staple ™ Technology, Covidien, New Haven, Connecticut, United States). The staple line is routinely imbricated with a 2-0 non-absorbable suture while keeping the calibration tube in place. Then, the posterior wall of the duodenum is carefully dissected and divided using a 60mm endoscopic linear stapler (Endo GIA ™ Curved Tip Reload with Tri-Staple ™ Technology, Covidien) 1 to 2cm distal to the pylorus. The limb length is 100cm for the biliopancreatic tract and 150cm for the alimentary tract. The jejunojejunostomy is performed with a 60mm linear stapler, and an entry hole is closed by hand- sewing. The mesenteric defect is closed by hand-sewing. The omentum is divided to avoid the tension of anastomosis during an antecolic reconstruction. A duodenojejunal end-to-side anastomosis is created by two layers of hand-sewn running suture. RESULTS The surgeries were performed by two Center of Excellence- designated surgeons. Laparoscopic approaches were successfully performed in all patients without conversion. The average skin-to- skin operation time and blood loss were 215±35 minutes (152–297 minutes) and 40±58 mL (0–230mL), respectively. The average postoperative hospital stay was 3.4±0.9 days (3–6 days). We encountered some non-life- TABLE 1. Results at 1 year after LSG-DJB BEFORE-OP (N=37) AFTER 1 YEAR (N=34) HbA1c < 6% without meds 0/37 (0%) 13/34 (38%) HbA1c < 6.5% without meds 0/37 (0%) 19/34 (56%) HbA1c < 7% with/without meds *after intensive med. control 5/37 (14%) 25/34 (74%) Composite endpoint (HbA1c < 7% sBP < 130mmHg, LDL-C < 100mg/dL) 1/37 (3%) 8/34 (24%) *Three patients who did not come to the hospital for 1 year follow up were excluded. Figure 1. Scheme of LSG-DJB

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