title: Laparoscopic Sleeve Gastrectomy for Morbid Obesity with Intra-operative Endoscopy: Lessons We Learned After 100 Consecutive Patients.
abstract: BACKGROUND
  Sleeve gastrectomy has become the second most common bariatric operation due to its low rates of morbidity and mortality, satisfactory treatment of patients' obesity, and resolution of associated co-morbidities. According to standard technique, calibration of the stomach is performed with varying sizes of bougies while use of intra-operative endoscopy has only sparsely been reported.
  
  
  METHODS
  Between 2004 and 2013, 100 patients have undergone laparoscopic or robotic sleeve gastrectomy with intra-operative endoscopic guidance. Technical aspects of the operation, results concerning morbidity, progressive weight loss, and resolution of co-morbidities were retrospectively reviewed.
  
  
  RESULTS
  Morbidity and mortality was zero. Rates of excess weight loss at 6 months and 1 and 3 years were 52.1, 67.4, and 61.3 %, respectively. Patients' highest rate of excess weight loss was achieved 18 months post-operatively. These rates were inversely related with preoperative age, body mass index, and the existence of preoperative co-morbidities.
  
  
  CONCLUSIONS
  Sleeve gastrectomy with intra-operative endoscopic guidance is at least as safe and effective as with the bougie. Given the available expertise and equipment, the use of this technique can increase the intra-operative sense of safety with no compromise or even improvement of the immediate or long-term results.
authors.affiliation: 1st Surgery Department, Laikon General Hospital, National and Kapodistrian University of Athens, Agiou Thoma 17, Athens, Greece, antreasalexandrou@hotmail.com.
authors.forename: Alexandrou
authors.initials: A
authors.lastname: Andreas
authors.forename: Michalinos
authors.initials: M
authors.lastname: Adamantios
authors.forename: Athanasiou
authors.initials: A
authors.lastname: Antonios
authors.forename: Rosenberg
authors.initials: R
authors.lastname: Theofilos
authors.forename: Tsigris
authors.initials: T
authors.lastname: Christos
authors.forename: Diamantis
authors.initials: D
authors.lastname: Theodoros
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009767:Obesity, Morbid / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss