Search

Background Laparoscopic sleeve gastrectomy is commonly performed using multiple ports. The quest to minimize surgical trauma has led to the development of single port laparoscopy, which has been shown to be a safe, less-invasive method of performing a variety of abdominal surgeries. We describe the feasibility and safety of single port sleeve gastrectomy (SPSG) for morbid obesity at an academic affiliate of a university hospital. Methods A total of 25 patients undergoing elective SPSG were compared with a demographically similar contemporaneous cohort of 9 patients who underwent standard multiple port laparoscopic sleeve gastrectomy. The data collected included the operative time, narcotic consumption, duration of patient controlled analgesia use, subjective pain scores, and length of stay. Results The patients undergoing SPSG experienced significantly less pain at 1 hour postoperatively ( P = .039). No statistically significant difference was found in pain between the 2 groups at 12 and 24 hours ( P = .519 and P = .403, respectively). The quantity of narcotic use ( P = .538), duration of patient controlled analgesia use ( P = .820), and length of stay ( P = .571) were not significantly different between the 2 groups. The operative time for SPSG was 118 minutes versus 101 minutes for multiple port surgery ( P = .160). Conclusions SPSG is safe and feasible for selected patients. The patients undergoing SPSG reported significantly less pain at the first postoperative hour. No significant differences between the 2 groups were seen in any of the other postoperative parameters.

Background This study examined the feasibility of using Polyflex stents in the treatment of enteric leaks after various bariatric operations. Chronic and acute leaks were treated. Methods We performed a retrospective case series review. Four patients received 6 Polyflex stents to treat complications of bariatric surgery. Two presented with early sepsis before stenting. One presented with abdominal pain. One presented with a chronic persistent fistula with an associated abscess. Stenting was performed under endoscopy with fluoroscopic guidance. The stents were left in place for 6 weeks. Results All patients tolerated a clear liquid diet within 24 hours of stenting and were able to be advanced to a pureed diet. All patients improved clinically after stenting. Three patients with acute leaks sealed their leaks after stent placement. One patient with a chronic leak persisted and required operative closure after a second stent was placed and failed. All patients experienced short-term nausea, as well as early satiety that lasted the duration of the stenting. One patient experienced hypersialisis while the stent was in place. Two stents migrated, although this had no effect on leak closure. One patient had an anastomotic stenosis successfully treated with a second stent. Conclusions Polyflex stents are useful in bypassing acute upper intestinal leaks after various bariatric operations. They provide a temporary bridge for wound healing with continued oral intake. Stenting provides a minimally invasive option in the management of acute leaks and, in our experience, had no serious associated morbidity.

Rachel Fetner, M.D.*, James McGinty, M.D., Colleen Russell, Ph.D., F. Xavier Pi-Sunyer, M.D., M.P.H., Blandine Laferrere, M.D. Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, St. Luke’s-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York Department of Surgery, Division of Bariatric Surgery, St. Luke’s-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York Obesity Research Center, St. Luke’s-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York Manuscript received April 28, 2005; revised August 5, 2005; accepted September 2, 2005

laparoscopic gastrojejunostomy revision, pouch reduction and truncal vagotomy. Results: No intraoperative complications occurred. She was discharged on the 6 postoperative day tolerating liquids and tube eeds. At her 7-month postoperative visit, she had gained 13 lbs nd was tolerating a regular diet. onclusion: Pouch size reduction might not be sufficient to preent recurrence of marginal ulcerations. Adequate pouch reduction nd truncal vagotomy is then necessary in recurrent refractory lcers.

51.4%. Twenty four patients (37.5%) had type 2 diabetes mellitus at the time of surgery. Of these, at one year postoperatively, twelve patients (50.0% of diabetic patients) experienced remission of their diabetes and eight (33.3%) had decreased their medication usage. At 24 months this effect persisted with 13 patients (54.2%) experiencing resolution and 7 (29.1%) with improvement. Overall 83% of diabetics had improvement or resolution of their diabetes within 2 years of surgery. Conclusion: Laparoscopic sleeve gastrectomy results in marked and durable improvement in diabetes mellitus in morbidly obese patients.