RESUMEN
BACKGROUND: Morbidity after converting failed laparoscopic adjustable gastric banding (LAGB) to laparoscopic Roux-en-Y gastric bypass (LRYGB) is three- to fivefold higher than after primary LRYGB. Allowing a time interval between band removal and actual gastric bypass might reduce local inflammation and reduce morbidity. METHODS: This study is a retrospective single-center study of patients who needed conversion to LRYGB because of failed LAGB. Outcomes after conversion of LAGB to LRYGB in one or two steps were compared. RESULTS: Between October 2008 and June 2010, 23 patients had a conversion in one step (group A) while, in 14 patients, the conversion was carried out at least 2 months after band removal (group B). The mean duration of surgery in group A was 150 ± 39 min while it took 181 ± 39 min to complete both steps in group B (p=0.02). Length of stay in group A was 3 (3-8) days, but was 5 (4-8) days for the two steps in group B (p=0.004). During a follow-up of 6-23 months, one pulmonary embolism, one epigastric artery bleeding, and three anastomotic strictures occurred in group A, while no complications were observed in group B. The BMI dropped from 41.4 ± 6.7 to 28.7 ± 10.8 kg/m(2) in group A and from 43.8 ± 5.8 to 35.3 ± 7.55 kg/m(2) in group B. CONCLUSIONS: Operating time and hospital stay are increased when conversion is performed in two steps, but, in this small series, this strategy decreased morbidity and more specifically the rate of anastomotic strictures.
Asunto(s)
Derivación Gástrica/métodos , Gastroplastia , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias/prevención & control , Adulto , Índice de Masa Corporal , Constricción Patológica/prevención & control , Femenino , Estudios de Seguimiento , Humanos , Laparoscopía , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Reoperación/métodos , Estudios Retrospectivos , Riesgo , Estómago/cirugía , Insuficiencia del Tratamiento , Pérdida de PesoRESUMEN
BACKGROUND: Laproscopic single-site surgery is the natural evolution of minimally invasive surgery. METHODS: A 70-year-old male was planned for a resection of a gastric GIST (gastrointestinal stromal tumor). A Triport trocar (Olympus, Aartselaar, Belgium) was placed through a 2-cm periumbilical incision. Besides the placement of a Nathanson liver retractor in the subxiphoidal position, no additional trocars had to be added. The partial gastrectomy was carried out by using clinical prototypes of double-bended intruments and of a "goose neck" videolaparoscope, all specially designed for single-port surgery. RESULTS: Total operative time was 140 minutes, and estimated blood loss was 10 mL. No intra- or postoperative complications occurred. Hospital stay was 4 days. Final pathology revealed the complete resection of a GIST tumor of gastric origin. CONCLUSIONS: We have demonstrated the technical feasibility and described the detailed surgical technique of laparoendoscopic single-site surgery gastric wedge resection.