title: Intraabdominal partitioning of the laparoscopic sleeve gastrectomy remnant optimizes the specimen extraction ergonomics and postoperative pain and is an attractive technique in teenage patients.
abstract: BACKGROUND
  Laparoscopic sleeve gastrectomy (LSG) has become an increasingly popular bariatric procedure in the pediatric population worldwide. The fear of complications, postoperative pain, and recovery remain the reservations for wider application of surgery in morbidly obese children. We present a novel technique for LSG remnant retrieval.
  
  
  METHODS
  The patient was a 16-year old girl with a body mass index of 55 kg/m(2) and significant comorbidities who underwent LSG and liver biopsy. In the extraction technique, a specimen containing the gastric body and fundus, approximately 80% of the stomach volume, was partitioned longitudinally and intracorporeally with endoshears; subsequently, it was retrieved in one fragment via the lumen of a 15-mm port.
  
  
  RESULTS
  The procedure time was 65 minutes (specimen extraction time was 7 minutes). Her recovery was uneventful, and she was discharged home on the second postoperative day. At the 1-, 3-, and 6-month follow-up, she has shown all the benefits of weight loss and associated improvement in metabolic parameters and quality of life, without any complications.
  
  
  CONCLUSIONS
  This technique for gastric remnant retrieval results in minimizing postoperative pain, reducing operative costs, and minimizing the likelihood of wound infection.
authors.affiliation: 1 Department of Surgery, New York Methodist Hospital , Brooklyn, New York.
authors.forename: Piotr
authors.initials: P
authors.lastname: Gorecki
authors.forename: Josue
authors.initials: J
authors.lastname: Chery
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lee
authors.forename: Anthony
authors.initials: A
authors.lastname: Tortolani
authors.forename: Wojciech
authors.initials: W
authors.lastname: Gorecki
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D015897:Comorbidity; D006804:Ergonomics; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005748:Gastric Fundus; D018530:Gastric Stump / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D010149:Postoperative Pain; D011788:Quality of Life; D013270:Stomach / Q000601:surgery; D015431:Weight Loss