Bariatric Times - Supplement A - Covidien - (Page 3)

THE 2007 INTERNATIONAL CONSENSUS SUMMIT ON SLEEVE GASTRECTOMY Laparoscopic Sleeve Gastrectomy: From Magenstrasse and Mill to Sleeve by MICHAEL J. MCMAHON, ChM, PhD, MD (HON), FRCS AUTHOR AFFILIATIONS: Dr. McMahon is Professor of Surgery, University of Leeds, England. ADDRESS CORRESPONDENCE TO: E-mail: mjm@lapsurg.co.uk isappointed with the results of vertical banded gastroplasty (VBG), but supportive of the concept of a bariatric operation that preserved gastric morphology and function, David Johnston devised the Magenstrasse and Mill (MM) procedure. The name embodied the concept of preservation of the gastric “street” as well as the mixing function of the antrum. In essence, a hole was punched out near the lesser curve at the junction of body and antrum using an annular stapling gun. This permitted linear staplers to be inserted alongside a bougie in order to obtain a long, stapled tube that was separated throughout its length from the greater curve aspect of the body and fundus of the stomach. When the operation was devised in 1987, a 40-French bougie was used, but this has been gradually reduced in calibre with experience. Excess weight loss at three years was 19 percent with the 40-French bougie but was 63 D percent after three years using a 32French bougie.1 We were keen to replicate the technique laparoscopically, and this was done with David Johnston starting in 1999. By far, the most difficult part of the procedure was the creation of the circular hole, and it seemed logical to eliminate this step by commencing the staple line on the greater curve, stapling across to the bougie and then up alongside the bougie to create the sleeve. An occasional but very troublesome complication with the MM procedure was the development of a gastric fistula from the staple line on the greater curve aspect of the divided stomach. By removing all of the stomach to the left of the staple line, this complication could be avoided. This had not been done in “open” surgery because of the risk of bleeding from the short gastric vessels. With the view obtained and the availability of ultrasonic shears, laparoscopic surgery seemed to decrease this risk, and we created a sleeve around a 32-French bougie, removing the redundant stomach, as a stand-alone bariatric procedure. Prior to this evolution, we had performed the laparoscopic MM procedure in six patients. Initially they did well, but by five years, excess weight loss (EWL) was only about 40 percent. Subsequently, three of the patients have been converted to gastric bypass with satisfactory further weight loss. Although numbers are small, the patients who underwent the laparoscopic MM appeared to have fared less well than the subsequent patients who underwent sleeve gastrectomy. Perhaps we were making the gastric tube a little less narrow, but the fact that food could gain access to the body and fundus of the stomach made the operation less efficient for the achievement of weight loss (as is the case with VBG) than sleeve gastrectomy or gastric bypass. We have now carried out more Sleeve gastrectomy appears particularly suited to patients in whom a bypass procedure is undesirable because of conditions such as inflammatory bowel disease or prior bowel resection. [JUNE 2008, SUPPLEMENT A] Bariatric Times 3

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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