Introduction: Sleeve gastrectomy(SG) as a bariatric procedure was introduced by Marceau, where-in he modified Scopinaro’s bilio-pancreatic division by adding a longitudinal gastric resection. [1] Although initially introduced as a first-stage procedure, Laparoscopic Sleeve Gastrectomy(LSG) has gained popularity as a primary restrictive bariatric procedure. The ASMBS,in it’s updated position statement on sleeve gastrectomy (SG) as a bariatric procedure, recognises SG as an acceptable primary bariatric procedure and also as a first stage procedure in high risk patients. [2] A recent report by the American College of Surgeons-Bariatric Surgery Center Network, which evaluated 28616 patients, reported that the reduction in BMI and other weight related
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Of these 10 were successfully treated by Controlled radial Expansion(CRE) balloon dilatation, 11 were successfully treated by Achalasia Balloon dilatation and 5 patients requires temporary placement of Self Expandable Metal Stents(SEMS). Ramya Kalaiselvan & Basil J.Ammori [9]describe a novel technique of laparoscopic median gastrectomy in 2 patients that presented with stenosis after LSG. Giovanni Dapri & Guy Bernard Cadière & Jacques Himpens [10] describe a technique of laparoscopic seromyotomy of long segment stenosis in 9 patients receiving LSG either as a standalone procedure(4) or as part of duodenal switch(5). Natan Zundel et al [11]report a incidence of 0.26%(3 patients) in a case series of 1155 patients who underwent LSG, over a period of 4 years. One patient underwent a re-laparoscopy to remove a hematoma behind the sleeve. The other two patients were managed by gastric tube dilatation. Amit Parikh et al [12] report a incidence of 3.5%(8 patients) in a case series of 230 patients. All patients responded to endoscopic pneumatic balloon …show more content…
We believe that the technique we present is a novel one and not described previously. Our technique for prevention of stenosis after LSG, utilizes routine intra operative endoscopy to visualize the gastric lumen after the staple line has been over-sewn. After insufflation, we try to evaluate the tube for any excessive curve at the level of the incisura angularis. Any visualized excessive curve is corrected by fixing the lesser curvature at that level to the gastro-hepatic ligament. During this procedure, the endoscope is maintained in-situ and we can visualize the straightening of the curve after the suture fixation. Since the adoption of this technique from ______ onwards, our clinical stenosis rate after LSG is 0%. We do accept the limitations of our
Of these 10 were successfully treated by Controlled radial Expansion(CRE) balloon dilatation, 11 were successfully treated by Achalasia Balloon dilatation and 5 patients requires temporary placement of Self Expandable Metal Stents(SEMS). Ramya Kalaiselvan & Basil J.Ammori [9]describe a novel technique of laparoscopic median gastrectomy in 2 patients that presented with stenosis after LSG. Giovanni Dapri & Guy Bernard Cadière & Jacques Himpens [10] describe a technique of laparoscopic seromyotomy of long segment stenosis in 9 patients receiving LSG either as a standalone procedure(4) or as part of duodenal switch(5). Natan Zundel et al [11]report a incidence of 0.26%(3 patients) in a case series of 1155 patients who underwent LSG, over a period of 4 years. One patient underwent a re-laparoscopy to remove a hematoma behind the sleeve. The other two patients were managed by gastric tube dilatation. Amit Parikh et al [12] report a incidence of 3.5%(8 patients) in a case series of 230 patients. All patients responded to endoscopic pneumatic balloon …show more content…
We believe that the technique we present is a novel one and not described previously. Our technique for prevention of stenosis after LSG, utilizes routine intra operative endoscopy to visualize the gastric lumen after the staple line has been over-sewn. After insufflation, we try to evaluate the tube for any excessive curve at the level of the incisura angularis. Any visualized excessive curve is corrected by fixing the lesser curvature at that level to the gastro-hepatic ligament. During this procedure, the endoscope is maintained in-situ and we can visualize the straightening of the curve after the suture fixation. Since the adoption of this technique from ______ onwards, our clinical stenosis rate after LSG is 0%. We do accept the limitations of our