title: Laparoscopic sleeve gastrectomy with an extensive posterior mobilization: technique and preliminary results.
abstract: BACKGROUND
  Laparoscopic sleeve gastrectomy (LSG) is becoming increasingly popular as a stand-alone procedure for the treatment of morbidly obese patients. A direct posterior approach to the angle of His was developed at our department to improve visualization of the difficult dissection of the short gastric vessels and to facilitate proper mobilization of the stomach around the left crus enabling safe realization of a tight sleeve. The technique and its preliminary results are described.
  
  
  METHODS
  LSG by posterior approach was performed in a consecutive series of 445 (110 male/335 female, age 18-63 years, mean body mass index 46 kg/m(2) (range 35-76)) patients between 2007 and 2010.
  
  
  RESULTS
  Weight loss defined as mean percent excess weight loss (%EWL) was 71% (±26%) at 1 year, 69% (±25%) at 2 years, and 55% (±27%) at 3 years. Sixteen patients (4%) developed postoperative intra-abdominal hematoma, 8 patients (2%) anastomotic leakage, and 6 patients intra-abdominal abscess (1%), requiring reoperation in 20 patients (4%). Five patients (1%) had pulmonary embolism. Thirty-day mortality rate was 0.2%.
  
  
  CONCLUSIONS
  LSG by the posterior approach is a safe and effective procedure, enabling a tight sleeve formation leading to satisfactory %EWL results. Since long-term results of LSG are unknown, further studies are needed to define the exact place of the LSG as a stand-alone bariatric procedure.
authors.affiliation: Department of Surgery, Sint Franciscus Gasthuis, Kleiweg 500, 3045 PM, Rotterdam, the Netherlands.
authors.forename: Ralph P M
authors.initials: RP
authors.lastname: Gadiot
authors.forename: Lacer Ulas
authors.initials: LU
authors.lastname: Biter
authors.forename: Hans J F
authors.initials: HJ
authors.lastname: Zengerink
authors.forename: Robert J
authors.initials: RJ
authors.lastname: de Vos tot Nederveen Cappel
authors.forename: Jan Willem F
authors.initials: JW
authors.lastname: Elte
authors.forename: Manuel
authors.initials: M
authors.lastname: Castro Cabezas
authors.forename: Guido H H
authors.initials: GH
authors.lastname: Mannaerts
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D005743:Gastrectomy / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D056888:Patient Positioning / Q000379:methods*; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult