Published in:
01-12-2020 | Sleeve Gastrectomy | Multimedia Article
Single-Incision Transumbilical Laparoscopic Sleeve Gastrectomy
with a Stomach Retractor in 20 Superobese Patients—a Video Vignette
Authors:
Liang Wang, Xuejing Zheng, Qing Sang, Dexiao Du, Dongbo Lian, Nengwei Zhang
Published in:
Obesity Surgery
|
Issue 12/2020
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Abstract
Background
The safety and feasibility of single-incision transumbilical
laparoscopic sleeve gastrectomy (SITU-LSG) have been proven in obese patients,
with great aesthetics. However, it is not performed in superobese patients (BMI
≥ 50 kg/m2). We aimed to introduce the technical
details of SITU-LSG with a stomach retractor in superobese patients.
Methods
Twenty superobese patients with a range of BMI from 50.00 to
55.77 kg/m2 underwent stomach retractor–assisted
SITU-LSG. An intraoperative laparoscopic video has been anonymized and edited to
demonstrate the course of the operation on superobese patient.
Results
The stomach retractor has a mini grasper end, which can be opened
with external force and closed without force, and it was inserted from a 1.5-mm
incision at the left upper abdomen. A Kirschner needle (K-needle) was inserted
into the right diaphragmatic crura to retract the liver so that the pylorus and
fundus of the stomach could be exposed adequately. Traction on the omentum majus
and insertion of 34 Fr. Bougie tube were achieved with the aid of the stomach
retractor. When endovascular gastrointestinal anastomosis staplers (Endo-GIAs)
were used to resect the stomach, the resected gastric tissue was retracted by
the stomach retractor. During the reinforce of staple line, the stomach
retractor was used to press the proximal end of staple line into the purse
string and immobilize the gastric sleeve. After surgery, the patients underwent
uneventful postoperative courses.
Conclusions
The stomach retractor facilitates SITU-LSG. The combinatory
procedure is safe, feasible, and effective in superobese patients.