Laparoscopic Sleeve Gastrectomy

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Laparoscopic Sleeve Gastrectomy
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Goals

• Review History
• Pathophysiology
• Sleeve Technique
• Results/Complications
• Issues

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32Fr
(Street)
(5-6cm)
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History Sleeve

• Leeds, UK 1992-1998
• Obes Surg 1310-16, 2003
• n123
• Midline incision, 32 Fr Bougie
• EEA fired just beyond Angularis
• GIA staplers to Angle of His

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History Sleeve

• Con't Obes Surg 13, 2003
• Results
• 5/123 (4) operative complications
• 1 bleed Left hepatic vein pericardial Effusion
• 1 Fistula with abscess PE
• 2 abscess (2 re-op panc, spleen, stomach
  gastric resection)
• 1 splenectomy
• 8 ventral hernia

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Magenstrasse and Mill Gastroplasty

• Results
• EWL _at_ 1 yr 58, _at_ 2 yr 61
• Stable _at_ 5 yr
• 72 of patients lost gt 50 EWL
• No dysphagia (no dilatations)
• 6 constipation
• GERD 28 dissipated with Weight loss

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Mechanism of Sleeve

• Effects on Ghrelin levels
• Obes Surg 15 1024-1029, 2005
• 10 Sleeve vs 10 Band
• Results
• Sleeve DECREASED Ghrelin levels at 1 day, 1
  month, 6 months
• Band showed NO change at 1 day and sig increased
  levels at 1 6 months
• EWL Sleeve vs. Band greater at 6 months (61 vs
  29)

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Mechanism of Sleeve

• Con't Obes Surg151024-1029, 2005
• Conclusions
• Effect of Sleeve secondary
• Hormonal
• Resection of Fundus has greater area of ghrelin
  production
• Restrictive components

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POD 1
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Overall Outcomes

• ASMBS web site
• EWL _at_ 1 year for 775 patients 33-88
• Complications 0-24
• Mortality 0.39 (3/775)

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Complications

• Leak
• Abscess
• Hemorrhage
• Stricture
• GERD
• Dumping