title: Sleeve gastrectomy with wrapping using polytetrafluoroethylene to prevent gastric enlargement in a porcine model.
abstract: BACKGROUND
  The safety and efficacy of laparoscopic sleeve gastrectomy followed by biliopancreatic diversion with duodenal switch for morbid obesity has been well established. We previously recommended 2-stage laparoscopic biliopancreatic diversion with duodenal switch for super-super obese patients. In the 2-stage version, these patients undergo laparoscopic sleeve gastrectomy as a first-stage procedure, followed by laparoscopic biliopancreatic diversion with duodenal switch as the second stage for more definitive treatment of their obesity. However, short-term weight regain may occur owing to gastric dilation after initial laparoscopic sleeve gastrectomy. The aim of this study was to prevent gastric dilation after sleeve gastrectomy. We designed a sleeve gastrectomy with wrapping using polytetrafluoroethylene dual mesh.
  
  
  METHODS
  Eleven Yorkshire pigs weighing 20-25 kg underwent sleeve gastrectomy with wrapping using polytetrafluoroethylene dual mesh (wrapping group) or sleeve gastrectomy only (control group) to compare the weight loss. The animals were weighed weekly postoperatively. Necropsy was performed 8 weeks postoperatively to confirm the wrapping by pathologic report.
  
  
  RESULTS
  Four pigs died because of staple line failure or strangulation; no perioperative complications occurred in the other pigs. The operative time for the control group was 198 +/- 60 minutes and for the wrapping group was 181 +/- 86 minutes (P = NS). The average weight of the removed stomach was 123.3 +/- 5.8 g in the control group and 140.3 +/- 69.9 g in the wrapping group (P = NS). The postoperative weight gain at 8 weeks was significantly slower in the wrapping group than in the control group (P <.0001). The pathologic necropsy report noted that the mesh was well attached to the stomach wall at 9 days postoperatively, with no unexpected deaths.
  
  
  CONCLUSIONS
  Sleeve gastrectomy with wrapping using polytetrafluoroethylene dual mesh is feasible, and weight gain was reduced in the porcine model.
authors.affiliation: Department of Surgery, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, New York, USA.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Ueda
authors.forename: Michel
authors.initials: M
authors.lastname: Gagner
authors.forename: Luca
authors.initials: L
authors.lastname: Milone
authors.forename: Sergio J
authors.initials: SJ
authors.lastname: Bardaro
authors.forename: Ke
authors.initials: K
authors.lastname: Gong
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D004108:Dilatation, Pathologic / Q000517:prevention & control; D005743:Gastrectomy / Q000379:methods*; D010535:Laparoscopy; D023421:Models, Animal; D009767:Obesity, Morbid / Q000601:surgery; D010865:Pilot Projects; D011138:Polytetrafluoroethylene; D013526:Surgical Mesh; D013552:Swine
chemical_list: D011138:Polytetrafluoroethylene