Bariatric Times - Supplement A - Covidien - (Page 19)

THE 2007 INTERNATIONAL CONSENSUS SUMMIT ON SLEEVE GASTRECTOMY Prevention and Treatment of GERD/Hiatal Hernia and Stenosis Associated with Sleeve Gastrectomy by GREGG H. JOSSART, MD; and PAUL T. CIRANGLE, MD AUTHOR AFFILIATIONS: Drs. Jossart and Cirangle are from the Laparoscopic Associates of San Francisco, California. ADDRESS CORRESPONDENCE TO: Dr. Gregg Jossart, 2100 Webster Street, Suite 110, San Francisco, CA 94115; Phone: (415) 561-1310; Fax (415) 561-1713; E-mail: gjossart@lapsf.com KEY POINTS • Repair hiatal hernias. • Avoid creating stenosis, angulation, and enlarged proximal segments. • Maintain liquid diet for 3 to 4 weeks. • Treat cardiospasm and gastritis prophylactically. • Perform a prompt evaluation and treatment to avoid dehydration and thiamine deficiency. he sleeve gastrectomy is a restrictive procedure created by a gastrectomy. This gastrectomy reduces total acid producing volume. The pouch that remains is long and narrow, and has an intact lower esophageal sphincter (LES) and pylorus. This pouch has a high degree of resistance to the flow of liquids and solids in the early months after surgery. It can also develop significant spasms, gastritis, and anatomical points of narrowing—all of which require prompt diagnosis and treatment. The clinical manifestations of these problems will present with a progressive inability to tolerate liquids, progressive dysphagia, vomiting, reflux, and regurgitation in the early weeks after surgery. These symptoms can be minimized through good surgical technique, proper education, slow dietary advancement, and prescription T medications to treat or prevent the underlying pathology. Most importantly, the surgeon cannot assume that the patient is not compliant and that an anatomical problem does not exist. Patients with progressively worsening symptoms of dysphagia, reflux, and vomiting are at risk for dehydration and acute thiamine deficiency. They must undergo prompt evaluation and treatment of these underlying problems. SURGICAL TECHNIQUE Good surgical technique is critical in minimizing postoperative obstructive symptoms. If a hiatal hernia is present, it must be repaired. A hiatal dissection can be performed with reduction of the hernia and closure of the hiatus. We close the hiatus posteriorly with one or two sutures. The closure is slightly loose around a 32-French bougie. If a hiatal hernia SUPPLEMENT A] [JUNE 2008, Bariatric Times 19

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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