Anatomic landmarks for laparoscopic gastric sleeve resection in obese patients with type 2 diabetes mellitus

Background. The widespread use of laparoscopy has greatly accelerated the development of bariatric/metabolic surgery. Mastering of the laparoscopic techniques in bariatric surgery is important considering the potential complications and their implications for the patient’s life. Laparoscopic sleeve gastrectomy is a common bariatric/metabolic procedure worldwide. This procedure seems relatively standard, but some steps of this procedure still depends on the choice of the surgeon. There are two main steps that are not standardized yet — the choice of the calibration bougie and the distance from the pylorus to the first staple. The objective of the study is to establish the anatomical landmarks of the beginning of staplerfiring, which are simple, constant, and which can be used to standardize laparoscopic gastric sleeve resection. Materials and methods. Thirty-six obese patients with type 2 diabetes mellitus undergo laparoscopic sleeve gastrectomy. Body measurements, such an age, gender, height, weight, body mass index, and carbohydrate metabolism parameters, such as glucose, glycated hemoglobin, insulin, C-peptide, HOMA index was analyzed. The distance from the gastric pylorus was measured intraoperatively using a silicone tape. Results and discussion. The study included 19 women and 17 men, with an average age of 50.3 ± 9.6 years (range 30—67 years). The average body mass index is 50.6 ± 10.9 kg/m2 (range 30.2—82.3 kg/m2). The average distance from the pylorus to the first branch of the gastroepiploic artery, which runs in the transverse direction to the axis of the antrum, was 41 ± 1.7 mm (range 38—44 mm). The average distance for women was 40.6 ± 1.6 mm, for men — 41.5 ± 1.6 mm. Conclusion. The first branch of the gastroepiploic artery which runs perpendicularly to the axis of the antrum can be used as constant anatomical landmark. It is located on average 41 mm proximal to the gastric pylorus. Using this landmark for the first stapler firing allows to offset the n