Bariatric Times - Supplement A - Covidien - (Page 11)

THE 2007 INTERNATIONAL CONSENSUS SUMMIT ON SLEEVE GASTRECTOMY Laparoscopic Sleeve Gastrectomy as an Initial Weight Loss Procedure for High-Risk Patients with Morbid Obesity by SAMER G. MATTAR, MD, FACS AUTHOR AFFILIATIONS: Dr. Mattar is Associate Professor of Surgery, Indiana University Medical Center, and Medical Director, Clarian Bariatrics,Indianapolis, Indiana. ADDRESS CORRESPONDENCE TO: Samer G. Mattar, MD, FACS, Clarian Bariatrics, 6625 Network Way, Indianapolis, IN 46278; Phone: (317) 275-6010; Fax: (317) 275-7012; E-mail: smattar@clarian.org BACKGROUND Surgical treatment of obesity in the high-risk, high body mass index (BMI) patient can be a technical and anesthetic challenge. Major morbidity and mortality in these patients can approach 38 percent and six percent, respectively. Attempts at reducing risk by both facilitating the technical components and anesthesia time are always an appealing concept. In an effort to achieve more favorable outcomes, we have employed a two-stage approach to such highrisk patients. This study evaluates our initial outcomes incorporating the sleeve gastrectomy in a staged strategy. The laparoscopic sleeve gastrectomy (LSG) is associated with fewer surgical maneuvers and no anastomoses, and was therefore considered a suitable selection as a preliminary stage. METHODS In this study, patients underwent laparoscopic sleeve gastrectomy as a first stage during the period of January 2002, through February 2004, at the University of Pittsburgh Medical Center. The gastrectomies were performed by longitudinally resecting at least two-thirds of the stomach, with the line of resection that initiated at the antrum at a point that was 5cm proximal to the pylorus, and extended toward the angle of His. This resection was done parallel to and alongside a 46–50 Fr bougie inserted by the anesthesiologist and directed towards the pylorus under direct vision. A barium swallow was performed on the first postoperative day, after which patients were offered a liquid diet. Patients were considered eligible for stage II laparoscopic Roux-en-Y gastric bypass (LRYGBP) after at least six months or after a weight loss of greater than 100 pounds and significant risk reduction. After achieving significant weight loss and reduction in comorbidities, these patients then proceeded with the second stage, which was LRYGBP. No staple buttressing material was used, but fibrin glue was applied to the staple line as a sealant to minimize staple line leakage. RESULTS During this study time, 126 patients underwent laparoscopic sleeve gastrectomy (53% female). The mean age was 49.5±0.9 years, and the mean BMI was 65.3±0.8 (range 45–91). Operative risk assessment determined that 42 [JUNE 2008, SUPPLEMENT A] Bariatric Times 11

Table of Contents Feed for the Digital Edition of Bariatric Times - Supplement A - Covidien

Bariatric Times - Supplement A - Covidien Contents Laparoscopic Sleeve Gastrectomy: From Magenstrasse And Mill To Sleeve Sleeve Gastrectomy Provides Resoultion of Type-2 Diabetes Without Duodenal Exclusion The Relationship Bewtween The Resected Remnant And Weight Loss Laparoscopic Sleeve Gastrectomy: Results After Two And Five Years Laparoscopic Sleeve Gastrectomy As An Initial Weight Loss Procedure For High-Risk Patients With Morbid Obesity Three-Year Results Of Laparoscopic Sleeve Gastrectomy In The Treatment Of Morbid Obesity In Korea Laparoscopic Sleeve Gastrectomy: Nutritional Concerns And PostOperative Dietary Care Laparoscopic Sleeve Gastrectomy: Prevention And Treatment Of Bleeding Prevention And Treatment Of Gerd/Hiatal Hernia And Stenosis Associated With Sleeve Gastrectomy Laparoscopic Revisions Of Sleeve Gastrectomy Survey Results

Bariatric Times - Supplement A - Covidien

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