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Yang J, Widjaja J, Wang R, Dong W, Yang D, Song H, Song Z, Gu Y. Routine gastric suspension technique in single-port sleeve gastrectomy procedure. Surg Endosc 2023; 37:9651-9657. [PMID: 37891372 DOI: 10.1007/s00464-023-10502-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/23/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Due to limited technical demand, single-port sleeve gastrectomy (SPSG) is a feasible laparoscopic technique for sleeve gastrectomy (SG). Nonetheless, difficulties exist when performing the single-port technique, and in this study, we aim to describe a slight maneuver that can improve the SPSG procedure. METHODS Patients who underwent laparoscopic SG between January 2022 and May 2023 at our hospital were included. The patients were classified into two groups: (1) SPSG and (2) multiple-port SG (MPSG). The parameters for this analysis were the patients' age, gender, weight, body mass index (BMI), conversion rate, drainage placement, 30-day readmission rate, and postoperative complications. Postoperative one-month and three-month percentages of total weight loss (%TWL) were calculated and compared. RESULTS 171 patients were included in this study: (1) the SPSG group (n = 96) and (2) the MPSG group (n = 75). No statistically significant difference was observed within the preoperative (age, gender, height, weight, and BMI) and the perioperative parameters between SPSG and MPSG (operation time, drainage placement, 30-day readmission) (p > 0.05). Per Clavien-Dindo's grading, two patients in the SPSG group suffered grade 1 complications; for the MPSG group, one patient sustained grade 2 and another suffered grade 3b complication. No statistical significance was observed on the %TWL between the two groups (p > 0.05). CONCLUSION Our study found that performing SPSG in specific patient is feasible and non-inferior when compared to the MPSG. Further studies will be needed to elucidate better the efficacy and safety of performing SPSG.
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Affiliation(s)
- Jianjun Yang
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, 200040, People's Republic of China
| | - Jason Widjaja
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, 200040, People's Republic of China
| | - Rui Wang
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, 200040, People's Republic of China
| | - Wenpei Dong
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, 200040, People's Republic of China
| | - Dongchao Yang
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, 200040, People's Republic of China
| | - Heng Song
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, 200040, People's Republic of China
| | - Zhicheng Song
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, 200040, People's Republic of China
| | - Yan Gu
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, 200040, People's Republic of China.
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Sanders DL, Pawlak MM, Simons MP, Aufenacker T, Balla A, Berger C, Berrevoet F, de Beaux AC, East B, Henriksen NA, Klugar M, Langaufová A, Miserez M, Morales-Conde S, Montgomery A, Pettersson PK, Reinpold W, Renard Y, Slezáková S, Whitehead-Clarke T, Stabilini C. Midline incisional hernia guidelines: the European Hernia Society. Br J Surg 2023; 110:1732-1768. [PMID: 37727928 PMCID: PMC10638550 DOI: 10.1093/bjs/znad284] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/08/2023] [Accepted: 08/02/2023] [Indexed: 09/21/2023]
Affiliation(s)
- David L Sanders
- Academic Department of Abdominal Wall Surgery, Royal Devon University
Foundation Healthcare Trust, North Devon District Hospital,
Barnstaple, UK
- University of Exeter Medical School,
Exeter, UK
| | - Maciej M Pawlak
- Academic Department of Abdominal Wall Surgery, Royal Devon University
Foundation Healthcare Trust, North Devon District Hospital,
Barnstaple, UK
- University of Exeter Medical School,
Exeter, UK
| | - Maarten P Simons
- Department of Surgery, OLVG Hospital Amsterdam,
Amsterdam, The
Netherlands
| | - Theo Aufenacker
- Department of Surgery, Rijnstate Hospital Arnhem,
Arnhem, The Netherlands
| | - Andrea Balla
- IRCCS San Raffaele Scientific Institute,
Milan, Italy
| | - Cigdem Berger
- Hamburg Hernia Centre, Department of Hernia and Abdominal Wall Surgery,
Helios Mariahilf Hospital Hamburg, Teaching Hospital of the University of Hamburg,
Hamburg, Germany
| | - Frederik Berrevoet
- Department for General and HPB Surgery and Liver Transplantation, Ghent
University Hospital, Ghent, Belgium
| | | | - Barbora East
- 3rd Department of Surgery at 1st Medical Faculty of Charles University,
Motol University Hospital, Prague, Czech Republic
| | - Nadia A Henriksen
- Department of Gastrointestinal and Hepatic Diseases, University of
Copenhagen, Herlev Hospital, Copenhagen, Denmark
| | - Miloslav Klugar
- The Czech National Centre for Evidence-Based Healthcare and Knowledge
Translation (Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Masaryk
University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of
Medicine, Masaryk University, Brno, Czech Republic
| | - Alena Langaufová
- Department of Health Sciences, Faculty of Medicine, Masaryk
University, Brno, Czech
Republic
| | - Marc Miserez
- Department of Abdominal Surgery, University Hospital Gasthuisberg, KU
Leuven, Leuven, Belgium
| | - Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General and
Digestive Surgery, University Hospital Virgen del Rocio, University of
Sevilla, Sevilla, Spain
| | - Agneta Montgomery
- Department of Surgery, Skåne University Hospital,
Malmö, Sweden
- Department of Clinical Sciences, Malmö Faculty of Medicine, Lund
University, Lund, Sweden
| | - Patrik K Pettersson
- Department of Surgery, Skåne University Hospital,
Malmö, Sweden
- Department of Clinical Sciences, Malmö Faculty of Medicine, Lund
University, Lund, Sweden
| | - Wolfgang Reinpold
- Hamburg Hernia Centre, Department of Hernia and Abdominal Wall Surgery,
Helios Mariahilf Hospital Hamburg, Teaching Hospital of the University of Hamburg,
Hamburg, Germany
| | - Yohann Renard
- Reims Champagne-Ardennes, Department of General, Digestive and Endocrine
Surgery, Robert Debré University Hospital, Reims,
France
| | - Simona Slezáková
- The Czech National Centre for Evidence-Based Healthcare and Knowledge
Translation (Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Masaryk
University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of
Medicine, Masaryk University, Brno, Czech Republic
| | - Thomas Whitehead-Clarke
- Centre for 3D Models of Health and Disease, Division of Surgery and
Interventional Science, University College London,
London, UK
| | - Cesare Stabilini
- Department of Surgery, University of Genoa,
Genoa, Italy
- Policlinico San Martino, IRCCS, Genoa,
Italy
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3
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Ataya K, Bsat AM, Aljaafreh A, Al Ayoubi AR, Al Tannir AH. Single Incision Versus Conventional Multiport Laparoscopic Sleeve Gastrectomy: Meta-Analysis and Systematic Review. Cureus 2023; 15:e46956. [PMID: 38022298 PMCID: PMC10640720 DOI: 10.7759/cureus.46956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Laparoscopic sleeve gastrectomy (LSG) is the most widely performed bariatric surgery and has been associated with excellent outcomes and a significant reduction in obesity-related morbidity and mortality. Traditionally, this surgery is performed using five to seven trocars. However, LSG performed through a single trocar is emerging as a less invasive method of performing this surgery. This systematic review and meta-analysis compare the outcomes and complication rates of single-port versus multi-port LSG. We searched PubMed, Medline, Scopus, and the Cochrane Library for articles published from 2008 to 2023, in accordance with the PRISMA 2020 guidelines. Data on variables such as operative time, excess weight loss, intraoperative bleeding, postoperative leak, and incisional hernia rates were collected and analyzed using a random-effects model. Fourteen articles met the inclusion criteria and were included in the meta-analysis. No significant differences were found between the single-port LSG (SILSG) and conventional LSG (CLSG) groups in terms of operative time, rate, intraoperative complications, length of hospital stay, postoperative complications, and excess weight loss (EWL). Furthermore, single incision sleeve gastrectomy showed better satisfaction with the cosmetic score. SILSG is a viable alternative procedure, showing comparable outcomes to multiport conventional sleeve gastrectomy, in addition, to a better cosmetic satisfaction score.
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Affiliation(s)
- Karim Ataya
- Upper Gastrointestinal Surgery, King's College Hospital, London, GBR
| | - Ayman M Bsat
- General Surgery, American University of Beirut Medical Center, Beirut, LBN
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4
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Abdelsamee KS, Matar M, Khalil MM. Short-term outcomes of reduced versus conventional ports in sleeve gastrectomy: A controlled clinical trial. Niger J Clin Pract 2023; 26:1472-1482. [PMID: 37929523 DOI: 10.4103/njcp.njcp_23_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Aim The study aims to compare the short-term outcomes of reduced ports sleeve gastrectomy versus conventional five ports sleeve gastrectomy in postoperative weight loss, morbidity rate, pain, and resolution of obesity-related diseases. Materials and Methods One hundred forty patients were equally allocated to reduced ports (n = 70) and conventional ports (5 ports) Laparoscopic Gastrectomy groups. The primary outcomes are postoperative pain by numeric rating score, cosmetic visual analog score, satisfaction visual analog score, operative time, and hospital stay. The secondary outcomes are postoperative complications and comorbidity resolution. Results The numeric rating score for pain assessment was statistically significantly lower in the reduced ports group compared with the conventional ports group at 2, 6, 12, and 24 hours, postoperatively (P < .001). Cosmetic visual analog score was statistically significantly higher in the reduced ports group compared with conventional ports group at 2 and 3 months follow-up (P < .001 and P = .008, respectively). Patient satisfaction visual analog score was statistically significantly higher in the reduced ports group than the conventional ports group at 2 and 3 months follow-up (P < .001 and P = .032, respectively). Conclusion Reduced ports laparoscopic sleeve gastrectomy is safe and feasible in patients with body mass index (BMI) up to 50 kg/m2. It is cosmetically well appreciated with noticeable patient satisfaction. It should be practiced with regularity. Further trials should be considered in patients with high BMI (>50 kg/m2).
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Affiliation(s)
- K S Abdelsamee
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Egypt
| | - M Matar
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Egypt
| | - M M Khalil
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Egypt
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Aiolfi A, Bona D, Ogliari C, Bonitta G, Bonavina L. Letter to the Editor: Role of Preoperative High-Resolution Manometry in the Identification of Patients at High Risk of Postoperative GERD Symptoms 1 Year After Sleeve Gastrectomy. Obes Surg 2023; 33:3307-3308. [PMID: 37610698 DOI: 10.1007/s11695-023-06806-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 07/23/2023] [Accepted: 08/18/2023] [Indexed: 08/24/2023]
Affiliation(s)
- Alberto Aiolfi
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157, Milan, Italy.
| | - Davide Bona
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157, Milan, Italy
| | - Cristina Ogliari
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157, Milan, Italy
| | - Gianluca Bonitta
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157, Milan, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
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6
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Jiang Z, Zhang Z, Feng T, Cheng Y, Zhang G, Zhong M, Hu S. Trocar number and placement for laparoscopic sleeve gastrectomy and comparison of single-incision and conventional laparoscopic sleeve gastrectomy: a systematic review and meta-analysis. Int J Surg 2023; 109:1783-1795. [PMID: 37068794 PMCID: PMC10389429 DOI: 10.1097/js9.0000000000000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/06/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Conventional laparoscopic sleeve gastrectomy (CLSG) has been conducted in multiple centers for treating morbid obesity, however, there are no standard criteria for (1) placing the trocar; and (2) how many trocars should be used. Single-incision laparoscopic sleeve gastrectomy (SLSG), a newly emerged technique in 2008, has been proposed as an alternative to CLSG in recent years, however, there is no definite evidence for this. MATERIALS AND METHODS A systematic literature search was performed using the PubMed, Embase, Web of Science, and Cochrane Library databases for laparoscopic sleeve gastrectomy cases from January 2006 to October 2022. We then summarized the trocar numbers and placement patterns among these studies. A meta-analysis was conducted to compare the difference between SLSG and CLSG in the perioperative and postoperative indices. RESULTS A total of 61 studies involving 20 180 patients who underwent laparoscopic sleeve gastrectomy for treating morbid obesity were included in the systematic review, including 11 on SLSG, 35 on CLSG, and 15 studies comparing SLSG and CLSG. A systematic review showed that the trocar number varied in different CLSG studies, mainly using four or five trocars. The trocars were mainly placed in position, presenting an inverted trapezoid pattern and a left-predominant pattern. Meta-analysis showed that the operative time in the SLSG was significantly higher than that in the CLSG, and the pain Visual Analog Scale rating on postoperative day 1 in the CLSG was significantly higher than in the SLSG. There were no statistical significances in the other complications or surgical efficiency. CONCLUSIONS In the CLSG, the majority of the trocars were arranged in an inverted trapezoid pattern and were of the left-predominant type. Although SLSG is a feasible technique in selected patients, there is insufficient evidence to recommend its widespread use compared with CLSG. High-quality randomized controlled trials with large study populations and long follow-up periods will be required in the future.
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Affiliation(s)
- Zhengchen Jiang
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University
| | - Zhao Zhang
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University
| | - Tianyi Feng
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University
| | - Yugang Cheng
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, China
| | - Guangyong Zhang
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, China
| | - Mingwei Zhong
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, China
| | - Sanyuan Hu
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University
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7
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Kang SH, Yoo M, Hwang D, Lee E, Lee S, Park YS, Ahn SH, Suh YS, Kim HH. Postoperative pain and quality of life after single-incision distal gastrectomy versus multiport laparoscopic distal gastrectomy for early gastric cancer - a randomized controlled trial. Surg Endosc 2023; 37:2095-2103. [PMID: 36307602 PMCID: PMC9616415 DOI: 10.1007/s00464-022-09709-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/11/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although it has been more than ten years since its first introduction, single-incision distal gastrectomy (SIDG) still lacks solid evidence and there are also no reports on patient quality of life (QOL). This study evaluates the postoperative outcomes and patient QOL of SIDG compared to multiport laparoscopic distal gastrectomy (MLDG). METHODS This study was designed as a prospective phase II randomized controlled study. Patients diagnosed with early gastric cancer in the distal 2/3rd of the stomach were randomized to either multiport or single-port group. Primary endpoint was pain using the visual analogue scale on postoperative day (POD) 1. Other outcomes include operative data, complications, and patient QOL using the EORTC C30 and STO22 modules. RESULTS A total of 43 patients in the SIDG group and 40 patients in the MLDG group were enrolled from September 2017 to February 2020. Mean operation time was 154.3 ± 53.3 min in the MLDG group and 148.9 ± 50.1 min in the SIDG group (p = 0.631). There was no difference in POD1 pain scores between the two groups (MLDG = 4.0 ± 1.3, SIDG = 4.3 ± 1.3, p = 0.372). Mean hospital stay was 5.5 (range 4-12) days in the MLDG group and 5 (range 4-17) days in the SIDG group (p = 0.993). There was no statistical significance in postoperative QOL scores. CONCLUSION Unlike previous reports, there was no difference in POD1 pain scores between SIDG and MLDG. Nevertheless, SIDG did not increase short-term morbidity compared to MLDG and had similar outcomes in QOL.
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Affiliation(s)
- So Hyun Kang
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, 13620, Gyenggi-Do, Korea
| | - Mira Yoo
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, 13620, Gyenggi-Do, Korea
| | - Duyeong Hwang
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, 13620, Gyenggi-Do, Korea
| | - Eunju Lee
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, 13620, Gyenggi-Do, Korea
| | - Sangjun Lee
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, 13620, Gyenggi-Do, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, 13620, Gyenggi-Do, Korea.
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
| | - Yun-Suhk Suh
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, 13620, Gyenggi-Do, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, 13620, Gyenggi-Do, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Patient-tailored algorithm for laparoscopic cruroplasty standardization: comparison with hiatal surface area and medium-term outcomes. Langenbecks Arch Surg 2022; 407:2537-2545. [PMID: 35585260 DOI: 10.1007/s00423-022-02556-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/11/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Different methods have been described for laparoscopic hiatoplasty and hiatus hernia (HH) repair. All techniques are not standardized and the choice to reinforce or not the hiatus with a mesh is left to the operating surgeon's preference. Hiatal surface area (HSA) has been described as an attempt at standardization; in case the area is > 4 cm2, a mesh is used to reinforce the repair. OBJECTIVE The aim of this study was to describe a new patient-tailored algorithm (PTA), compare its performance in predicting crura mesh buttressing to HSA, and analyze outcomes. METHODS Retrospective, single-center, descriptive study (September 2018-September 2021). Adult patients (≥ 18 years old) who underwent laparoscopic HH repair. Outcomes and quality of life measured with the disease-specific gastroesophageal reflux disease health-related quality of life (GERD-HRQL) and reflux symptom index (RSI) were analyzed. RESULTS Fifty patients that underwent laparoscopic hiatoplasty and Toupet fundoplication were included. The median age was 61 years (range 32-83) and the median BMI was 26.7 (range 17-36). According to the PTA, 27 patients (54%) underwent simple suture repair while crural mesh buttressing with Phasix-ST® was used in 23 (46%). According to the HSA, the median hiatus area was 4.7 cm2 while 26 patients had an HSA greater than 4 cm2. The overall concordance rate between PTA and HSA was 94% (47/50). The median hospital stay was 1.9 days (range 1-8) and the 90-day complication rate was 4%. The median follow-up was 18.6 months (range 1-35). Hernia recurrence was diagnosed in 6%. Postoperative dysphagia occurred in one patient (2%). The GERD-HRQL (p < 0.001) and RSI (p = 0.001) were significantly improved. CONCLUSIONS The application of PTA for cruroplasty standardization in the setting of HH repair seems effective. While concordance with HSA is high, the PTA seems easier and promptly available in the operative theater with a potential increase in procedure standardization, reproducibility, and teaching.
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Paraesophageal hernia repair with laparoscopic Toupet fundoplication: impact on pulmonary function, respiratory symptoms and quality of life. Hernia 2022; 26:1679-1685. [PMID: 35578061 DOI: 10.1007/s10029-022-02623-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/21/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Paraesophageal hiatal hernia (PEH) is characterized by protrusion of intra-abdominal organs into the posterior mediastinum. Respiratory symptoms and reduced pulmonary function have been described as possibly related to lung compression. OBJECTIVE To assess the effect of laparoscopic Toupet fundoplication (LTF) for PEH repair on pulmonary function, measured with pulmonary function tests (PFTs), and respiratory symptoms. METHODS Retrospective, single-center, cohort study (November 2015-2020). All patients that completed pre- and postoperative (12 months) PFTs assessment were included. The gastroesophageal reflux disease health-related quality of life (GERD-HRQL), reflux symptom index (RSI) and short form-36 (SF-36) were used. RESULTS Overall, 71 patients were included. The median age was 67.1 years and the majority were females (78.8%). Baseline PFTs were within normal limits in 91% of patients. At 12 month follow-up, total lung capacity (TLC) (4.77 vs. 5.07 L; p = 0.0251), vital capacity (VC) (2.97 vs. 3.31 L; p = 0.0065), forced expiratory volume in one second (FEV1) (2.07 vs. 2.44 L; p < 0.001) and forced vital capacity (FVC) (2.78 vs. 3.19 L; p < 0.001) were significantly improved. No significant differences were found for diffusing capacity of lung for carbon monoxide (DLCO) (17.09 vs. 17.24; p = 0.734), and FEV1/FVC (0.77 vs. 0.77; p = 0.967). Interestingly, improvements were more pronounced in patients with large PEH (type IIIb and IV). At 12 month follow-up, both gastrointestinal and respiratory symptoms were significantly improved and 94% of patients were satisfied with the operation. The GERD-HRQL (18.1 ± 7.9 vs. 4.01 ± 2.4; p = 0.001), RSI (37.8 ± 9.7 vs. 10.6 ± 8.9; p < 0.001) and all SF-36 items were improved. CONCLUSIONS LTF for the treatment of PEH is safe and seems to be effective up to 12 month follow-up with improved lung volumes, spirometry values, quality of life, gastrointestinal and respiratory symptoms.
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Laparoscopic management of pathologic gastroesophageal reflux after sleeve gastrectomy using the magnetic sphincter augmentation (MSA) device-a Video Vignette. Obes Surg 2022; 32:1791-1793. [PMID: 35290612 PMCID: PMC8986733 DOI: 10.1007/s11695-022-06007-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/27/2022] [Accepted: 03/08/2022] [Indexed: 11/08/2022]
Abstract
Purpose The development of gastroesophageal reflux disease (GERD) has been shown to be not infrequent after laparoscopic sleeve gastrectomy (LSG). Management may vary from medical therapy to Roux-en-Y gastric bypass (RYGB) conversion. Magnetic sphincter augmentation (MSA) device has been shown to be a promising option with excellent results. The purpose of this video was to demonstrate the laparoscopic management of post-LSG GERD with MSA device implant. Materials and Methods An intraoperative video has been edited to demonstrate the MSA device placement after LSG for the treatment of pathologic GERD. Results The procedure started with the lysis of the perigastric adhesions to free the distal esophagus circumferentially. The posterior vagus nerve was identified, and a small window was created between the posterior esophageal wall anteriorly and the vagus nerve posteriorly. A hiatoplasty was performed using two non-resorbable interrupted 2.0 Prolene® sutures. The system’s sizer was placed to measure the junctional circumference. A 15-mm MSA device was implanted. Conclusion MSA device placement seems technically feasible and safe with promising results in term of improved LES resting pressure and esophageal acid exposure. While future studies are necessary to corroborate these preliminary indications, MSA device may possibly become a valid option in surgeon armamentarium. Supplementary Information The online version contains supplementary material available at 10.1007/s11695-022-06007-x.
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11
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Aiolfi A, Gagner M, Zappa MA, Lastraioli C, Lombardo F, Panizzo V, Bonitta G, Cavalli M, Campanelli G, Bona D. Staple Line Reinforcement During Laparoscopic Sleeve Gastrectomy: Systematic Review and Network Meta-analysis of Randomized Controlled Trials. Obes Surg 2022; 32:1466-1478. [PMID: 35169954 PMCID: PMC8986671 DOI: 10.1007/s11695-022-05950-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/25/2022] [Accepted: 02/03/2022] [Indexed: 11/29/2022]
Abstract
Purpose Staple line reinforcement (SLR) during laparoscopic sleeve gastrectomy (LSG) is controversial. The purpose of this study was to perform a comprehensive evaluation of the most commonly utilized techniques for SLR. Materials and Methods Network meta-analysis of randomized controlled trials (RCTs) to compare no reinforcement (NR), suture oversewing (SR), glue reinforcement (GR), bioabsorbable staple line reinforcement (Gore® Seamguard®) (GoR), and clips reinforcement (CR). Risk Ratio (RR), weighted mean difference (WMD), and 95% credible intervals (CrI) were used as pooled effect size measures. Results Overall, 3994 patients (17 RCTs) were included. Of those, 1641 (41.1%) underwent NR, 1507 (37.7%) SR, 689 (17.2%) GR, 107 (2.7%) GoR, and 50 (1.3%) CR. SR was associated with a significantly reduced risk of bleeding (RR=0.51; 95% CrI 0.31–0.88), staple line leak (RR=0.56; 95% CrI 0.32–0.99), and overall complications (RR=0.50; 95% CrI 0.30–0.88) compared to NR while no differences were found vs. GR, GoR, and CR. Operative time was significantly longer for SR (WMD=16.2; 95% CrI 10.8–21.7), GR (WMD=15.0; 95% CrI 7.7–22.4), and GoR (WMD=15.5; 95% CrI 5.6–25.4) compared to NR. Among treatments, there were no significant differences for surgical site infection (SSI), sleeve stenosis, reoperation, hospital length of stay, and 30-day mortality. Conclusions SR seems associated with a reduced risk of bleeding, leak, and overall complications compared to NR while no differences were found vs. GR, GoR, and CR. Data regarding GoR and CR are limited while further trials reporting outcomes for these techniques are warranted. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s11695-022-05950-z.
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Affiliation(s)
- Alberto Aiolfi
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, n16, 20149, Milan, Italy.
| | | | - Marco Antonio Zappa
- UOC Chirurgia Generale Ospedale Fatebenefratelli, Asst Fatebenefratelli-Sacco Milano, Milan, Italy
| | - Caterina Lastraioli
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, n16, 20149, Milan, Italy
| | - Francesca Lombardo
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, n16, 20149, Milan, Italy
| | - Valerio Panizzo
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, n16, 20149, Milan, Italy
| | - Gianluca Bonitta
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, n16, 20149, Milan, Italy
| | - Marta Cavalli
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, n16, 20149, Milan, Italy
| | - Giampiero Campanelli
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, n16, 20149, Milan, Italy
| | - Davide Bona
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, n16, 20149, Milan, Italy
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12
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Caltabiano ML. Personality, weight loss and obesity-related well-being post-bariatric surgery. Eat Weight Disord 2022; 27:199-206. [PMID: 33723740 DOI: 10.1007/s40519-020-01086-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/28/2020] [Indexed: 12/01/2022] Open
Abstract
PURPOSE The aim of the study was to examine the associations between personality, weight loss and obesity-related well-being post-bariatric surgery. It was hypothesised that persons who had undergone bariatric surgery who exhibit Extraversion, Conscientiousness, Agreeableness and Intellect/Imagination will have greater obesity-related well-being; whereas, those low on Emotional stability will have poorer obesity well-being. METHOD The cross-sectional sample comprised 127 females who had received bariatric surgery. The average age of participants was 45 years. Quality of life was measured using the Obesity-Related Well-Being scale (ORWELL 97). Personality was assessed with the International Personality Item Pool (IPIP) 50-item measure of the Five-Factor Model. RESULTS The mean BMI for the sample was 34.13 (SD = 7.8). Females with a larger BMI who had undergone bariatric surgery had lower obesity-related well-being. Conscientiousness was negatively associated with BMI. Separate Hierarchical regression analyses found that Emotional stability (Beta = - .43, - .47, - .36) and Agreeableness (Beta = .27, .29, .25) predicted overall well-being, symptom occurrence and subjective relevance of distress, respectively. BMI predicted occurrence of symptoms (Beta = .23). CONCLUSIONS The findings have implications for the development of personality-informed interventions for bariatric patients in enhancing well-being and weight-loss maintenance following surgery. LEVEL OF EVIDENCE Level III: Evidence obtained from well-designed cohort or case-control analytic studies.
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Affiliation(s)
- Marie Louise Caltabiano
- Psychology, College of Healthcare Sciences, Division of Tropical Health & Medicine, James Cook University, McGregor Road, Smithfield, Cairns, Qld, 4878, Australia.
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13
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Aiolfi A, Cavalli M, Sozzi A, Lombardo F, Lanzaro A, Panizzo V, Bonitta G, Mendogni P, Bruni PG, Campanelli G, Bona D. Medium-term safety and efficacy profile of paraesophageal hernia repair with Phasix-ST ® mesh: a single-institution experience. Hernia 2022; 26:279-286. [PMID: 34716832 DOI: 10.1007/s10029-021-02528-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/17/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hernia recurrence after laparoscopic repair is a perplexing problem. In an effort to reduce anatomical and clinical recurrences, different type of meshes have been used to bolster the esophageal hiatus. OBJECTIVE The aim of this study was to assess safety, medium-term efficacy, and quality of life improvement after laparoscopic repair of hiatal hernia reinforced with a biosynthetic absorbable mesh (Phasix-ST®). METHODS Observational single-center retrospective single-arm cohort study (November 2015-February 2021). We included all adult patients (> 18 years old) who underwent laparoscopic paraesophageal hernia repair with Phasix-ST® mesh and Toupet fundoplication. RESULTS Sixty-eight patients were included. The median postoperative stay was 3.2 days (range 2-9) and the postoperative complication rate was 11.7%. The median follow-up time was 27 months (range 1-53). No mesh-related complications were detected. Hernia recurrence was diagnosed in six patients (8.8%). The recurrence-free probability at 34 months was 0.89 (95% CI 0.807-0.988) while at 60 months was 0.86 (95% CI 0.76-0.97). Hernia recurrences were mostly observed between 21 and 36 months after the operation. None of the patients required surgical revision and all were managed with PPI. Postoperative dysphagia requiring endoscopic balloon dilatation occurred in 2.9% of patients. Compared to baseline, both the GERD-HRQL (15.2 ± 6.2 vs. 3.2 ± 3.1; p = 0.026) and all SF-36 items were significantly improved (p < 0.001). CONCLUSIONS Laparoscopic crura augmentation with Phasix-ST® mesh combined with a Toupet fundoplication is safe and seems effective in the medium-term follow-up. Phasix-ST® crural reinforcement resulted in low hernia recurrence rate with a sustained symptoms and quality of life improvement.
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Affiliation(s)
- A Aiolfi
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy.
| | - M Cavalli
- Department of Surgery, University of Insubria, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - A Sozzi
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - F Lombardo
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - A Lanzaro
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - V Panizzo
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - G Bonitta
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - P Mendogni
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - P G Bruni
- Department of Surgery, University of Insubria, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - G Campanelli
- Department of Surgery, University of Insubria, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - D Bona
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
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14
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Lombardo F, Aiolfi A, Cavalli M, Mini E, Lastraioli C, Panizzo V, Lanzaro A, Bonitta G, Danelli P, Campanelli G, Bona D. Techniques for reconstruction after distal gastrectomy for cancer: updated network meta-analysis of randomized controlled trials. Langenbecks Arch Surg 2022; 407:75-86. [PMID: 35094151 DOI: 10.1007/s00423-021-02411-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/13/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The choice of the best reconstruction technique after distal gastrectomy (DG) remains controversial and still not defined. The purpose was to perform a comprehensive evaluation within the major type of intestinal reconstruction after DG for gastric cancer. METHODS Systematic review and network meta-analyses of randomized controlled trials (RCTs) to compare Billroth I (BI), Billroth II (BII), Billroth II Braun (BII Braun), Roux-en-Y (RY), and Uncut Roux-en-Y (URY). Risk ratio (RR) and weighted mean difference (WMD) were used as pooled effect size measures while 95% credible intervals (CrI) were used to assess relative inference. RESULTS Ten RCTs (1456 patients) were included. Of these, 448 (33.7%) underwent BI, 220 (15.1%) BII, 114 BII Braun (7.8%), 533 (36.6%) RY, and 141 URY (9.6%). No significant differences were found among treatments for 30-day mortality, anastomotic leak, anastomotic stricture, and overall complications. At 12-month follow-up, RY was associated with a significantly reduced risk of remnant gastritis compared to BI (RR=0.56; 95% Crl 0.35-0.76) and BII reconstruction (RR=0.47; 95% Crl 0.22-0.97). Similarly, despite the lack of statistical significance, RY seems associated with a trend toward reduced endoscopically proven esophagitis compared to BI (RR=0.58; 95% Crl 0.24-1.51) and bile reflux compared to BI (RR=0.48; 95% Crl 0.17-1.41), BII (RR=0.74; 95% Crl 0.20-2.81), and BII Braun (RR=0.65; 95% Crl 0.30-1.43). CONCLUSIONS This network meta-analysis shows that there are five main options for intestinal anastomosis after DG. All techniques seem equally safe with comparable anastomotic leak, anastomotic stricture, overall morbidity, and short-term outcomes. In the short-term follow-up (12 months), RY seems associated with a reduced risk of remnant gastritis and a trend toward a reduced risk of bile reflux and esophagitis.
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Affiliation(s)
- Francesca Lombardo
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - Alberto Aiolfi
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy.
| | - Marta Cavalli
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - Emanuele Mini
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - Caterina Lastraioli
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - Valerio Panizzo
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - Alessio Lanzaro
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - Gianluca Bonitta
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - Piergiorgio Danelli
- Department of Biomedical and Clinical Sciences, "Luigi Sacco" Hospital, University of Milan, Milan, Italy
| | - Giampiero Campanelli
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - Davide Bona
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
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Safety and effectiveness of reduced-port laparoscopic sleeve gastrectomy in Asian morbidly obese patients. Sci Rep 2021; 11:23511. [PMID: 34873253 PMCID: PMC8648717 DOI: 10.1038/s41598-021-02999-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/24/2021] [Indexed: 12/04/2022] Open
Abstract
Laparoscopic sleeve gastrectomy is the most frequently performed surgical intervention in patients with morbid obesity. Single-port sleeve gastrectomy (SPSG) and reduced-port sleeve gastrectomy (RPSG) are increasingly reported in the literature. This study compared the short-term outcomes of SPSG, RPSG, and conventional laparoscopic sleeve gastrectomy (CLSG). This is a single-center retrospective study of 238 morbidly obese patients, of whom 148 (62.2%) patients completed follow-up one year after surgery. Propensity score matching was performed on factors influencing the choice of approach, and fifty patients from the SPSG + RPSG and CLSG groups were successfully matched. The groups were comparable in postoperative weight loss, morbidity, pain, and resolution of obesity-related comorbidities. The percentage of excess weight loss after one year was 90.0% in the SPSG + RPSG group and 75.2% in the CLSG group (P < 0.001). Complication rates showed no significant difference. The CLSG group was superior in dyslipidemia remission (17 [37.0%] vs. 28 [63.6%], P = 0.018) in the total cohort; however, this difference disappeared after matching. Our results suggest that single-port and reduced-port approaches could be alternative choices for selected patients. As our study was limited by its retrospective nature and potential selection bias, further studies are necessary to set standardized guidelines for SPSG.
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Magnetic sphincter augmentation device removal: surgical technique and results at medium-term follow-up. Langenbecks Arch Surg 2021; 406:2545-2551. [PMID: 34462810 PMCID: PMC8578182 DOI: 10.1007/s00423-021-02294-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/03/2021] [Indexed: 02/07/2023]
Abstract
Background The magnetic sphincter augmentation (MSA) device has become a common option for the treatment of gastroesophageal reflux disease (GERD). Knowledge of MSA-related complications, indications for removal, and techniques are puzzled. With this study, we aimed to evaluate indications, techniques for removal, surgical approach, and outcomes with MSA removal. Methods This is an observational singe-center study. Patients were followed up regularly with endoscopy, pH monitoring, and assessed for specific gastroesophageal reflux disease health-related quality of life (GERD-HRQL) and generic short-form 36 (SF-36) quality of life. Results Five patients underwent MSA explant. Four patients were males and the median age was 47 years (range 44–55). Heartburn, epigastric/chest pain, and dysphagia were commonly reported. The median implant duration was 46 months (range 31–72). A laparoscopic approach was adopted in all patients. Intraoperative findings included normal anatomy (40%), herniation in the mediastinum (40%), and erosion (20%). The most common anti-reflux procedures were Dor (n = 2), Toupet (n = 2), and anterior partial fundoplication (n = 1). The median operative time was 145 min (range 60–185), and the median hospital length of stay was 4 days (range 3–6). The median postoperative follow-up was 41 months (range 12–51). At the last follow-up, 80% of patients were off PPI; the GERD-HRQL and SF-36 questionnaire were improved with DeMeester score and esophageal acid exposure normalization. Conclusion The MSA device can be safely explanted through a single-stage laparoscopic procedure. Tailoring a fundoplication, according to preoperative patient symptoms and intraoperative findings, seems feasible and safe with a promising trend toward improved symptoms and quality of life. Supplementary Information The online version contains supplementary material available at 10.1007/s00423-021-02294-7.
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Bona D, Lombardo F, Matsushima K, Cavalli M, Panizzo V, Mendogni P, Bonitta G, Campanelli G, Aiolfi A. Diaphragmatic herniation after esophagogastric surgery: systematic review and meta-analysis. Langenbecks Arch Surg 2021; 406:1819-1829. [PMID: 34129106 PMCID: PMC8481172 DOI: 10.1007/s00423-021-02214-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/23/2021] [Indexed: 11/30/2022]
Abstract
Introduction The anatomy of the esophageal hiatus is altered during esophagogastric surgery with an increased risk of postoperative hiatus hernia (HH). The purpose of this article was to examine the current evidence on the surgical management and outcomes associated with HH after esophagogastric surgery for cancer. Materials and methods Systematic review and meta-analysis. Web of Science, PubMed, and EMBASE data sets were consulted. Results Twenty-seven studies were included for a total of 404 patients requiring surgical treatment for HH after esophagogastric surgery. The age of the patients ranged from 35 to 85 years, and the majority were males (82.3%). Abdominal pain, nausea/vomiting, and dyspnea were the commonly reported symptoms. An emergency repair was required in 51.5%, while a minimally invasive repair was performed in 48.5%. Simple suture cruroplasty and mesh reinforced repair were performed in 65% and 35% of patients, respectively. The duration between the index procedure and HH repair ranged from 3 to 144 months, with the majority (67%) occurring within 24 months. The estimated pooled prevalence rates of pulmonary complications, anastomotic leak, overall morbidity, and mortality were 14.1% (95% CI = 8.0–22.0%), 1.4% (95% CI = 0.8–2.2%), 35% (95% CI = 20.0–54.0%), and 5.0% (95% CI = 3.0–8.0%), respectively. The postoperative follow-up ranged from 1 to 110 months (mean = 24) and the pooled prevalence of HH recurrence was 16% (95% CI = 13.0–21.6%). Conclusions Current evidence reporting data for HH after esophagogastric surgery is narrow. The overall postoperative pulmonary complications, overall morbidity, and mortality are 14%, 35%, and 5%, respectively. Additional studies are required to define indications and treatment algorithm and evaluate the best technique for crural repair at the index operation in an attempt to minimize the risk of HH.
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Affiliation(s)
- Davide Bona
- Division of General Surgery, Department of Biomedical Science for Health, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - Francesca Lombardo
- Division of General Surgery, Department of Biomedical Science for Health, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - Kazuhide Matsushima
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, IPT, C5L100, Los Angeles, CA, 90033, USA
| | - Marta Cavalli
- Department of Surgery, University of Insubria, Milan, Italy
| | - Valerio Panizzo
- Division of General Surgery, Department of Biomedical Science for Health, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - Paolo Mendogni
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via Francesco Sforza, 35, Milan, Italy
| | - Gianluca Bonitta
- Division of General Surgery, Department of Biomedical Science for Health, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | | | - Alberto Aiolfi
- Division of General Surgery, Department of Biomedical Science for Health, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy.
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Functional Laparoscopic Roux-en-Y Gastric Bypass with Fundectomy and Gastric Remnant Exploration (LRYGBfse)-a Video Vignette. Obes Surg 2021; 31:2350-2352. [PMID: 33616850 PMCID: PMC8041701 DOI: 10.1007/s11695-021-05298-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The laparoscopic Roux en-Y gastric bypass (LRYGB) is performed worldwide and is considered by many the gold standard treatment for morbid obesity. However, the difficult access to the gastric remnant and duodenum represents intrinsic limitations. The functional laparoscopic gastric bypass with fundectomy and gastric remnant exploration (LRYGBfse) is a new technique described in attempt to overcome the limitations of the LRYGB. The purpose of this video was to demonstrate the LRYGBfse in a 48-year-old man with type II diabetes and hypertension. METHODS An intraoperative video has been anonymized and edited to demonstrate the feasibility of LRYGBfse. RESULTS The operation started with the opening of the gastrocolic ligament. Staying close to the gastric wall, the stomach is prepared up to the angle of His. After the placement of a 36-Fr orogastric probe, gastric fundectomy is completed in order to create a 30cc gastric pouch. A polytetrafluoroethylene banding (ePTFE) is placed at the gastro-gastric communication, 7cm below the cardia, and gently closed after bougie retraction. The bypass is completed by the creation of an antecolic Roux-en-Y 150cm alimentary and 150cm biliopancreatic limb. CONCLUSION The LRYGBfse is a feasible and safe technique. The possibility to endoscopically explore the excluded stomach with an easy access to the Vater's papilla is a major advantage. Further studies are warranted to deeply explore and compare outcomes with the standard LRYGB.
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Aiolfi A, Micheletto G, Marin J, Rausa E, Bonitta G, Bona D. Laparoscopic Sleeve-Fundoplication for Morbidly Obese Patients with Gastroesophageal Reflux: Systematic Review and Meta-analysis. Obes Surg 2021; 31:1714-1721. [PMID: 33389630 PMCID: PMC8012327 DOI: 10.1007/s11695-020-05189-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/08/2020] [Accepted: 12/21/2020] [Indexed: 02/06/2023]
Abstract
Introduction Laparoscopic sleeve gastrectomy (LSG) has rapidly become popular with excellent results. However, LSG may exacerbate or increase the risk of “de novo” gastroesophageal reflux disease (GERD). Adding a fundoplication has been proposed to increase the lower esophageal sphincter competency. The aim of this study was to examine the current evidence and outcomes of sleeve-fundoplication (Sleeve-F). Materials and Methods Systematic review and meta-analysis. Web of Science, PubMed, and Embase data sets were consulted. Results Six studies (485 patients) met the inclusion criteria. The age of the patient population ranged from 17 to 72 years old and 82% were females. All patients underwent sleeve-fundoplication. Rossetti, Collis-Nissen, and Nissen were the most commonly performed fundoplications. The estimated pooled prevalence of postoperative leak, gastric perforation, and overall complications were 1.0% (95% CI = 0.0–2.0%), 2.9% (95% CI = 0.0–8.3%), and 9.8% (95% CI = 6.7–13.4%), respectively. The pooled reoperation rate was 4.1% (95% CI = 1.3–10%). There was no mortality. At 12-month follow-up, the estimated pooled BMI and %EWL were 29.9 kg/m2 (95% CI = 28.5–31.2) and 66.2% (95% CI = 59.3–71.1), respectively, while esophagitis, PPI consumption, and GERD rates were 8.0% (95% CI 3–21%), 7.8% (95% CI 5–13%), and 11% (95% CI 4–26%). Conclusions This systematic review and meta-analysis shows that current evidence for Sleeve-F is limited with high postoperative gastric perforation and overall complication rates. Weight loss and GERD resolution seem promising in the short term; however, further studies are warranted to explore long-term effects with instrumental investigations. Sleeve-F should be considered cautiously while future well-structured randomized trials are warranted. Supplementary Information The online version contains supplementary material available at 10.1007/s11695-020-05189-6.
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Affiliation(s)
- Alberto Aiolfi
- Department of Biomedical Science for Health, Division of General Surgery, Istitituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy.
| | - Giancarlo Micheletto
- Department of Pathophysiology and Transplantation, INCO and Department of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy
| | - Jacopo Marin
- Department of Pathophysiology and Transplantation, INCO and Department of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy
| | - Emanuele Rausa
- Department of Biomedical Science for Health, Division of General Surgery, Istitituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - Gianluca Bonitta
- Department of Biomedical Science for Health, Division of General Surgery, Istitituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - Davide Bona
- Department of Biomedical Science for Health, Division of General Surgery, Istitituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
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Resleeve for failed laparoscopic sleeve gastrectomy: systematic review and meta-analysis. Surg Obes Relat Dis 2020; 16:1383-1391. [PMID: 32682774 DOI: 10.1016/j.soard.2020.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/29/2020] [Accepted: 06/03/2020] [Indexed: 01/09/2023]
Abstract
Despite excellent long-term results, insufficient weight loss, weight regain, and pathologic gastroesophageal reflux disease may require revisional procedures after laparoscopic sleeve gastrectomy (LSG). Resleeve gastrectomy (ReSG) for failed LSG, has been proposed as an alternative to more complex malabsorptive procedures. The aim of this systematic review and meta-analysis was to examine the current evidence on the therapeutic role and outcomes of ReSG for failed LSG. PubMed, EMBASE, and Web of Science data sets were consulted. A systematic review and Frequentist meta-analysis were performed. Ten studies published between 2010 and 2019 met the inclusion criteria for a total of 300 patients. The age of the patient population ranged from 20 to 66 years old and 80.5% were females. The elapsed time between the LSG and ReSG ranged from 9 to 132 months. The estimated pooled prevalence of postoperative leak and overall complications were 2.0% (95% confidence interval [CI] = .5%-4.7%) and 7.6% (95%CI = 3.1%-13.4%). The estimated pooled mean operative time and hospital length of stay were 51 minutes (95%CI = 49.4-52.6) and 3.3 days (95%CI = 3.13-3.51). The postoperative follow-up ranged from 12 to 36 months and the estimated pooled mean percentage excess weight loss was 61.46% (95%CI = 55.9-66.9). The overall mortality ranged from 0% to 2.2%. ReSG after failed LSG seems feasible and safe with acceptable postoperative leak rate, overall complications, and mortality. The effectiveness of ReSG in term of weight loss seems promising in the short-term but further studies are warranted to explore its effect on patients' quality of life, postoperative gastroesophageal reflux disease, and long-term weight loss.
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Amiki M, Seki Y, Kasama K, Pachimatla S, Kitagawa M, Umezawa A, Kurokawa Y. Reduced-Port Sleeve Gastrectomy for Morbidly Obese Japanese Patients: a Retrospective Case-Matched Study. Obes Surg 2020; 29:3291-3298. [PMID: 31187457 DOI: 10.1007/s11695-019-03987-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Reduced-port laparoscopic surgery remains controversial due to technical challenges that can lead to suboptimal outcomes, and data pertaining to operative and clinical outcomes of reduced-port sleeve gastrectomy (RPSG) vs. conventional laparoscopic sleeve gastrectomy (CLSG) are lacking. AIMS This retrospective case-matched study aimed to compare midterm (2-year) outcomes of RPSG and of CLSG. METHODS Patients included in the study had undergone laparoscopic bariatric surgery at our center between 2010 and 2017. Thirty-one consecutive female patients who underwent RPSG were compared to a sex-, age-, body mass index-matched group of 31 patients who underwent CLSG. Outcomes were evaluated and compared between groups. RESULTS Estimated blood loss volume, incidences of intraoperative and postoperative complications, and length of postoperative hospital stay did not differ significantly between the 2 groups. Operation time was significantly greater in the RPSG group than in the CLSG group (148.7 ± 22.6 vs. 120.2 ± 25.9 min, respectively; p < 0.001). Excess weight loss at 1 year was 105.9% and 109.7%, respectively (p = 0.94) and at 2 years was 101.1% and 105.3%, respectively (p = 0.64). One RPSG patient required placement of additional trocars because of bleeding from short gastric vessels, but conversion to open surgery was not required. CONCLUSIONS RPSG is feasible in carefully selected bariatric patients and results in midterm outcomes comparable to those observed after CLSG. Good cosmesis is a potential benefit of RPSG.
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Affiliation(s)
- Manabu Amiki
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Yosuke Seki
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan.
| | - Kazunori Kasama
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Srinivasulu Pachimatla
- Ramdev Rao Memorial General Hospital, Sivananda Rehabilitation Home, National Highway No. 65 Metro Pillar No. 34, Kukutpally Hyderabad, Telangana, 500072, India
| | - Michiko Kitagawa
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Akiko Umezawa
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Yoshimochi Kurokawa
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
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Lesti G, Bona D, Sozzi A, Lesti F, Bonitta G, Zappa MA, Aiolfi A. Impact of Functional Laparoscopic Gastric Bypass with Fundectomy and Gastric Remnant Exploration (LRYGBfse) on Patients’ Quality of Life: Trajectory and 5-Year Follow-up Result. Obes Surg 2020; 30:3046-3053. [DOI: 10.1007/s11695-020-04650-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Lainas P, Derienne J, Dammaro C, Schoucair N, Devaquet N, Dagher I. Single-port Laparoscopic Surgery for the Treatment of Severe Obesity: Review and Perspectives. Obes Surg 2020; 30:2781-2790. [DOI: 10.1007/s11695-020-04620-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Caltabiano ML. Translational aspects of body image research for obesity-related quality of life and weight loss maintenance post-bariatric surgery. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:S2. [PMID: 32309406 PMCID: PMC7154329 DOI: 10.21037/atm.2019.09.63] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background The Aim of the study was to examine obesity health-related quality of life and body image satisfaction in a group of individuals having undergone bariatric surgery. Methods One hundred and forty-two persons who had undergone bariatric surgery answered an online survey which included measures of well-being and body image. The Multidimensional Body Self-Relations Questionnaire-Appearance Scales (MBSRQ-AS 34) was used to assess body image in relation to appearance evaluation (AE), appearance orientation (AO), overweight preoccupation (OP), self-classified weight (SCW), and body areas satisfaction (BASS). Obesity-related quality of life was assessed with the obesity related well-being scale (Orwell 97). Results Hierarchical multiple regression indicated that 50.2% of the variance in well-being post-surgery was explained by body image variables [F(6,84) =18.54, P<0.01], with the strongest predictor being satisfaction with body areas (B=−0.360, P<0.01). Regression analysis of the data for the group of patients who had received the vertical sleeve surgery was also significant, [F(6,56) =10.16, P<0.001] with satisfaction with different body areas being the best predictor of well-being (B=−0.365, P<0.05), followed by OP (B=0.313, P<0.05) and SCW (B=0.281, P<0.05). Conclusions Body image concerns are more important predictors for well-being post bariatric surgery than weight lost. Psychological factors such as the perception of body areas, continued weight preoccupation and SCW rather an objective weight were better predictors of well-being, symptoms that impacted on well-being and on the subjective relevance of the symptoms to well-being. Recommendations for the translation of the present research findings for the surgical preparation of the bariatric patient and for post-surgery care are suggested.
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Affiliation(s)
- Marie L Caltabiano
- Psychology, College of Healthcare Sciences, Division of Tropical Health & Medicine, James Cook University, Cairns, QLD, Australia
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Sun SD, Wu PP, Zhou JF, Wang ZS, Cai TH, Huang LK, Chen JS, Lin CQ, Wang JX, He QL. Comparison of Single-Incision and Conventional Laparoscopic Sleeve Gastrectomy for Morbid Obesity: a Meta-Analysis. Obes Surg 2020; 30:2186-2198. [PMID: 32060852 DOI: 10.1007/s11695-020-04437-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Single-incision laparoscopic sleeve gastrectomy (SILSG) has been proposed as an alternative to conventional laparoscopic sleeve gastrectomy (CLSG) in obese patients. This study aims to compare the surgical outcomes of these two techniques. METHODS A meta-analysis of existing literature obtained through a systematic literature search in the PubMed, EMBASE, and Cochrane Library CENTRAL databases from 2009 to 2019 was conducted. RESULTS Eleven articles including 1168 patients were analyzed. Patients in the SILSG group reported greater satisfaction with cosmetic scar outcomes than those in the CLSG group (SMD = 2.47, 95% CI = 1.10 to 3.83, P = 0.00). There was no significant difference between the SILSG group and the CLSG group regarding operative time, intraoperative estimated blood loss, conversion rate, intraoperative complications, length of hospital stay, postoperative analgesia, postoperative complications, excess weight loss (EWL), and improvements in comorbidities (P > 0.05). CONCLUSIONS Compared to CLSG, SILSG resulted in improved cosmetic satisfaction and showed no disadvantages in terms of surgical outcomes; thus, SILSG can serve as an alternative to CLSG for obese patients. Nonetheless, high-quality randomized controlled trials (RCTs) with large study populations and long follow-up periods are needed.
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Affiliation(s)
- Si-Da Sun
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Ping-Ping Wu
- Department of General Medicine, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Jun-Feng Zhou
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Zhi-Sheng Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Tian-Hong Cai
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Long-Kai Huang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Jian-Sheng Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Chang-Qing Lin
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Jia-Xing Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Qing-Liang He
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China.
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Abstract
Bariatric surgery research has focused predominantly on weight loss outcomes and complications of surgery in relation to the type of surgical procedure. The psychological impact of having bariatric surgery has received less attention. This study investigated whether patients who receive psychological counselling have better physical and mental well-being post-bariatric surgery. Eighty-eight persons (81 female, 7 male, M age 43.99 years) who had undergone weight loss surgery were recruited from bariatric surgery and obesity online support groups to answer an electronic survey which included the Health Survey Short Form (SF-12) to assess mental and physical well-being. Patients who had attended ≥ 6 counselling sessions after gastric sleeve surgery had better physical well-being, compared to those who attended < 6 sessions. Patients who attended between one and four psychological counselling sessions had significantly higher mental well-being. Psychological support for the mental health needs of obese patients post-surgery requires more attention.
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Mauriello C, Chouillard E, d'alessandro A, Marte G, Papadimitriou A, Chahine E, Kassir R. Retrospective Comparison of Single-Port Sleeve Gastrectomy Versus Three-Port Laparoscopic Sleeve Gastrectomy: a Propensity Score Adjustment Analysis. Obes Surg 2019; 28:2105-2112. [PMID: 29663249 DOI: 10.1007/s11695-018-3244-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE Evaluate the efficacy of single-port sleeve gastrectomy (SPSG) and then compare it to a less-invasive sleeve approach (three-port) (3PSG) according to a propensity score (PS) matching analysis. MATERIALS AND METHODS We analyzed all patients who underwent SG through a three-port or a single-port laparoscopic approach. RESULTS After 2 years, the follow-up was completed in 84% patients treated with 3PSG and 95% patients of the SPSG group. Excess weight loss (EWL) was comparable for the first year of follow-up within the two groups except for the controls at 3 months in which the SPSG group showed a higher EWL (p = 0.0243). CONCLUSION We demonstrated the efficacy of SPSG in bariatric surgery even compared to another, less invasive, laparoscopic SG approach (three-port).
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Affiliation(s)
- Claudio Mauriello
- Department of Digestive Surgery, Centre Hospitalier Intercommunal, Poissy, France
| | - Elie Chouillard
- Department of Digestive Surgery, Centre Hospitalier Intercommunal, Poissy, France
| | - Antonio d'alessandro
- Department of Digestive Surgery, Centre Hospitalier Intercommunal, Poissy, France
| | - Gianpaolo Marte
- Department of Surgery, Regional Center for HPB Surgery, Regional Hospital of Treviso, 31100, Treviso, Italy
| | - Argyri Papadimitriou
- Department of Digestive Surgery, Centre Hospitalier Intercommunal, Poissy, France
| | - Elias Chahine
- Department of Digestive Surgery, Centre Hospitalier Intercommunal, Poissy, France
| | - Radwan Kassir
- Department of Digestive Surgery, CHU Félix Guyon, La réunion, Saint Denis, France. .,Department of Bariatric Surgery, CHU Felix-Guyon, La réunion, Saint Denis, France.
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Tranchart H, Rebibo L, Gaillard M, Dhahri A, Lainas P, Regimbeau JM, Dagher I. Short-term outcomes of single-port versus conventional laparoscopic sleeve gastrectomy: a propensity score matched analysis. Surg Endosc 2019; 34:3978-3985. [PMID: 31595402 DOI: 10.1007/s00464-019-07175-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 09/26/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Sleeve gastrectomy (SG) has become a frequent bariatric procedure. Single-port sleeve gastrectomy (SPSG) could reduce parietal aggression however its development has been restrained due to fear of a complex procedure leading to increased morbidity and suboptimal sleeve construction. The aim of this study was to compare the short-term outcomes of SPSG versus conventional laparoscopic sleeve gastrectomy (CLSG) with regards to morbidity, weight loss, and co-morbidity resolution. METHODS Between January 2015 and December 2016, data from all consecutive patients that underwent SPSG and CLSG in two institutions performing exclusively one or the other approach were retrospectively analyzed. Propensity score adjustment was performed on the factors known to influence the choice of approach. RESULTS During the study period, 1122 patients underwent SG in both institutions (610 SPSG and 512 CLSG). From each group, 314 patients were successfully matched. A 15-min increase in operative time was observed during SPSG (P < 0.001). Postoperative morbidity was similar with a minor increase after SPSG (8.6 vs. 6.7%, P = 0.453). No differences in incisional hernia rates were observed (1.6 (SPSG) vs. 0.3% (CLSG), P = 0.216). Percentage of total weight loss was 31.1% and 28.2% in the CLSG and SPSG 12 months after surgery, respectively (P = 0.321). Co-morbidities resolution 12 months following the procedure was similar. CONCLUSIONS SPSG can be performed safely with similar intraoperative and postoperative morbidity compared to CLSG. Weight loss and co-morbidities resolution at 1 year are equivalent. A 15-min longer operative time was the only negative side of SPSG.
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Affiliation(s)
- Hadrien Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, 92140, Clamart, France.
- Paris-Saclay University, 91405, Orsay, France.
| | - Lionel Rebibo
- Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardie, 80054, Amiens, France
- Research Unit BQR SSPC « Simplification of Surgical Patient Care », Jules Verne University of Picardie, 80054, Amiens, France
| | - Martin Gaillard
- Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, 92140, Clamart, France
- Paris-Saclay University, 91405, Orsay, France
| | - Abdennaceur Dhahri
- Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardie, 80054, Amiens, France
- Research Unit BQR SSPC « Simplification of Surgical Patient Care », Jules Verne University of Picardie, 80054, Amiens, France
| | - Panagiotis Lainas
- Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, 92140, Clamart, France
- Paris-Saclay University, 91405, Orsay, France
| | - Jean-Marc Regimbeau
- Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardie, 80054, Amiens, France
- Research Unit BQR SSPC « Simplification of Surgical Patient Care », Jules Verne University of Picardie, 80054, Amiens, France
| | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, 92140, Clamart, France
- Paris-Saclay University, 91405, Orsay, France
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Pain Relief in the Sickle-Cell Crisis: Intravenous Morphine Versus Ketorolac; A Double-Blind, Randomized Clinical Trial. IRANIAN RED CRESCENT MEDICAL JOURNAL 2019. [DOI: 10.5812/ircmj.83614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
BACKGROUND Laparoscopy is a common procedure in many surgical specialties. Complications arising from laparoscopy are often related to initial entry into the abdomen. Life-threatening complications include injury to viscera (e.g. bowel, bladder) or to vasculature (e.g. major abdominal and anterior abdominal wall vessels). No clear consensus has been reached as to the optimal method of laparoscopic entry into the peritoneal cavity. OBJECTIVES To evaluate the benefits and risks of different laparoscopic entry techniques in gynaecological and non-gynaecological surgery. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility (CGF) Group trials register, CENTRAL, MEDLINE, Embase, PsycINFO, and trials registers in January 2018. We also checked the references of articles retrieved. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared one laparoscopic entry technique versus another. Primary outcomes were major complications including mortality, vascular injury of major vessels and abdominal wall vessels, visceral injury of bladder or bowel, gas embolism, solid organ injury, and failed entry (inability to access the peritoneal cavity). Secondary outcomes were extraperitoneal insufflation, trocar site bleeding, trocar site infection, incisional hernia, omentum injury, and uterine bleeding. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed risk of bias, and extracted data. We expressed findings as Peto odds ratios (Peto ORs) with 95% confidence intervals (CIs). We assessed statistical heterogeneity using the I² statistic. We assessed the overall quality of evidence for the main comparisons using GRADE methods. MAIN RESULTS The review included 57 RCTs including four multi-arm trials, with a total of 9865 participants, and evaluated 25 different laparoscopic entry techniques. Most studies selected low-risk patients, and many studies excluded patients with high body mass index (BMI) and previous abdominal surgery. Researchers did not find evidence of differences in major vascular or visceral complications, as would be anticipated given that event rates were very low and sample sizes were far too small to identify plausible differences in rare but serious adverse events.Open-entry versus closed-entryTen RCTs investigating Veress needle entry reported vascular injury as an outcome. There was a total of 1086 participants and 10 events of vascular injury were reported. Four RCTs looking at open entry technique reported vascular injury as an outcome. There was a total of 376 participants and 0 events of vascular injury were reported. This was not a direct comparison. In the direct comparison of Veress needle and Open-entry technique, there was insufficient evidence to determine whether there was a difference in rates of vascular injury (Peto OR 0.14, 95% CI 0.00 to 6.82; 4 RCTs; n = 915; I² = N/A, very low-quality evidence). Evidence was insufficient to show whether there were differences between groups for visceral injury (Peto OR 0.61, 95% CI 0.06 to 6.08; 4 RCTs; n = 915: I² = 0%; very low-quality evidence), or failed entry (Peto OR 0.45, 95% CI 0.14 to 1.42; 3 RCTs; n = 865; I² = 63%; very low-quality evidence). Two studies reported mortality with no events in either group. No studies reported gas embolism or solid organ injury.Direct trocar versus Veress needle entryTrial results show a reduction in failed entry into the abdomen with the use of a direct trocar in comparison with Veress needle entry (OR 0.24, 95% CI 0.17 to 0.34; 8 RCTs; N = 3185; I² = 45%; moderate-quality evidence). Evidence was insufficient to show whether there were differences between groups in rates of vascular injury (Peto OR 0.59, 95% CI 0.18 to 1.96; 6 RCTs; n = 1603; I² = 75%; very low-quality evidence), visceral injury (Peto OR 2.02, 95% CI 0.21 to 19.42; 5 RCTs; n = 1519; I² = 25%; very low-quality evidence), or solid organ injury (Peto OR 0.58, 95% Cl 0.06 to 5.65; 3 RCTs; n = 1079; I² = 61%; very low-quality evidence). Four studies reported mortality with no events in either group. Two studies reported gas embolism, with no events in either group.Direct vision entry versus Veress needle entryEvidence was insufficient to show whether there were differences between groups in rates of vascular injury (Peto OR 0.39, 95% CI 0.05 to 2.85; 1 RCT; n = 186; very low-quality evidence) or visceral injury (Peto OR 0.15, 95% CI 0.01 to 2.34; 2 RCTs; n = 380; I² = N/A; very low-quality evidence). Trials did not report our other primary outcomes.Direct vision entry versus open entryEvidence was insufficient to show whether there were differences between groups in rates of visceral injury (Peto OR 0.13, 95% CI 0.00 to 6.50; 2 RCTs; n = 392; I² = N/A; very low-quality evidence), solid organ injury (Peto OR 6.16, 95% CI 0.12 to 316.67; 1 RCT; n = 60; very low-quality evidence), or failed entry (Peto OR 0.40, 95% CI 0.04 to 4.09; 1 RCT; n = 60; very low-quality evidence). Two studies reported vascular injury with no events in either arm. Trials did not report our other primary outcomes.Radially expanding (STEP) trocars versus non-expanding trocarsEvidence was insufficient to show whether there were differences between groups in rates of vascular injury (Peto OR 0.24, 95% Cl 0.05 to 1.21; 2 RCTs; n = 331; I² = 0%; very low-quality evidence), visceral injury (Peto OR 0.13, 95% CI 0.00 to 6.37; 2 RCTs; n = 331; very low-quality evidence), or solid organ injury (Peto OR 1.05, 95% CI 0.07 to 16.91; 1 RCT; n = 244; very low-quality evidence). Trials did not report our other primary outcomes.Other studies compared a wide variety of other laparoscopic entry techniques, but all evidence was of very low quality and evidence was insufficient to support the use of one technique over another. AUTHORS' CONCLUSIONS Overall, evidence was insufficient to support the use of one laparoscopic entry technique over another. Researchers noted an advantage of direct trocar entry over Veress needle entry for failed entry. Most evidence was of very low quality; the main limitations were imprecision (due to small sample sizes and very low event rates) and risk of bias associated with poor reporting of study methods.
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Affiliation(s)
- Gaity Ahmad
- Pennine Acute Hospitals NHS TrustDepartment of Obstetrics and GynaecologyManchesterUK
| | - Jade Baker
- Pennine Acute Hospitals NHS TrustDepartment of Obstetrics and GynaecologyManchesterUK
| | | | - Kevin Phillips
- Castle Hill HospitalObstetrics and GynaecologyCastle RoadCottinghamNorth HumbersideUKHU16 5JQ
| | - Andrew Watson
- Tameside & Glossop Acute Services NHS TrustDepartment of Obstetrics and GynaecologyFountain StreetAshton‐Under‐LyneLancashireUKOL6 9RW
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Incidence of incisional hernias following single-incision versus traditional laparoscopic surgery: a meta-analysis. Hernia 2018; 23:91-100. [DOI: 10.1007/s10029-018-1853-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 11/08/2018] [Indexed: 12/14/2022]
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32
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Magouliotis DE, Tasiopoulou VS, Svokos AA, Svokos KA, Sioka E, Zacharoulis D. Single Incision Versus Conventional Laparoscopic Sleeve Gastrectomy for Morbid Obesity: A Meta-Analysis. J Laparoendosc Adv Surg Tech A 2018; 28:690-699. [DOI: 10.1089/lap.2017.0245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
| | - Vasiliki S. Tasiopoulou
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Viopolis, Larissa, Greece
| | | | | | - Eleni Sioka
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
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