title: Technical aspects of laparoscopic sleeve gastrectomy in 25 morbidly obese patients.
abstract: BACKGROUND
  Laparoscopic sleeve gastrectomy (LSG) has recently come to be performed as a sole bariatric operation. The postoperative morbidity and mortality are cause for concern, and possibly are related to non-standardized surgical technique.
  
  
  METHODS
  The following is the surgical LSG technique used in 25 morbidly obese patients. Five trocars are used. Division of the vascular supply of the greater gastric curvature is begun at 6-7 cm proximal to the pylorus, proceeding to the angle of His. A 50-Fr calibrating bougie is positioned against the lesser curvature. The LSG is created using a linear stapler-cutter device with one 4.1-mm green load for the antrum, followed by five to seven sequential 3.5-mm blue loads for the remaining gastric corpus and fundus. The staple-line is inverted by placing a sero-serosal continuous absorbable suture over the bougie from the angle of His. The resected stomach is removed through the 12-mm trocar, and a Jackson-Pratt drain is left along the suture-line.
  
  
  RESULTS
  The mean operative time was 120 minutes, and length of hospital stay was 4 +/- 2 days. There were no conversions to open procedures. There were no postoperative complications (no hemorrhage from the staple-line, no anastomotic leakage, no stricture) and no mortality. In 1 patient, cholecystectomy was also done, and in 4, a gastric band was removed. During a median follow-up of 4 months, BMI decreased from 43 +/- 5 kg/m2 to 34 +/- 6 kg/m2, and the % excess BMI loss was 49 +/- 25%.
  
  
  CONCLUSIONS
  The proposed surgical technique appears to be a safe and effective procedure for morbid obesity.
authors: Department of Surgery B, Felsenstein Research Center Rabin Medical Center, Petah Tiqva, Israel.
authors: Osnat
authors: O
authors: Givon-Madhala
authors: Rona
authors: R
authors: Spector
authors: Nir
authors: N
authors: Wasserberg
authors: Nahum
authors: N
authors: Beglaibter
authors: Hagit
authors: H
authors: Lustigman
authors: Michael
authors: M
authors: Stein
authors: Nazik
authors: N
authors: Arar
authors: Moshe
authors: M
authors: Rubin
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011446:Prospective Studies; D017792:Surgical Stapling; D016896:Treatment Outcome