Abstract: Objective:To explore the standardized procedures of laparoscopic sleeve gastrectomy (LSG).
Methods:The clinical data of 153 patients with obesity who underwent LSG at the First Affiliated Hospital of Nanjing Medical University from December 2010 to December 2014 were retrospectively analyzed. All the 153 patients were divided into 3 groups: 22 patients in the first stage group were admitted to the hospital from December 2010 to September 2011, 57 patients in the second stage group were admitted to the hospital from October 2011 to December 2013 and 74 patients in the third stage group were admitted to the hospital from January 2014 to December 2014. In the first stage group, 1.1 cm gastroscope in diameter was introduced into the pylorus as a support, great curve of stomach with 5 cm distances from the pylorus was cut using a green cartridge, and then blue cartridges were used at the body and fundus of stomach. The 3-0 vicryl continuous and wholelayer suture was performed. The routine abdominal drainage was ended at postoperative hour 24 without the gastric tube placement. In the second stage group, 36 Fr bougie tube was placed at the gastric antrum, cutting at the proximal 5 cm from pylorus was performed using a green cartridge, and then blue cartridges were used. The 3-0 Vicryl interrupted and wholelayer suture was performed at the reinforcement of staple lines, and no drainage tube was placed. In the third stage group, 36 Fr bougie tube was placed at the gastric antrum, cutting at the proximal 3 cm from pylorus was performed using two green cartridges, and then blue cartridges were used. The 3-0 vicryl continuous and wholelayer suture was performed at the reinforcement of staple lines, and no drainage tube was placed. Other common perioperative management included as follows: free greater omentum was done by the supersonic knife. Patients had outofbed activity after waking up and intake of water and fluid diet at postoperative hour 6-8, including oral liquid diet of 300-500 mL at postoperative hour 24 and 500-1 000 mL at postoperative hour 48. Patients were followed up till May 2015, and return visit at postoperative month 1, 3, 6, 9 and 12 within 1 year and once every 6 months after postoperative year 2. The operation time, volume of intraoperative blood loss, duration of hospital stay and excess weight loss (EWL) percentage were analyzed. Comparison of count data was analyzed by the chisquare test. Measurement data with normal distribution were presented as ±s. Comparisons among groups were evaluated with the oneway ANOVA and chisquare test.
Results:All the patients received successfully LSG without conversion to open surgery, perioperative reoperation and death. Four patients were complicated with intraoperative injury, including 3 patients with liver injury and 1 patient with hepatic round ligament injury. No intraoperative and postoperative hemorrhea, postoperative gastric leakage and obstruction were detected. The operation time, volume of intraoperative blood loss, duration of hospital stay and 1year EWL were (91±31) minutes, (51±33)mL, (4.1±3.4)days, 67%±12% in the first stage group, (56±27)minutes, (24±20)mL, (3.1±2.7)days, 65%±14% in the second stage group and (54±18)minutes, (21±20)mL, (3.0±2.1)days, 68%±24% in the third stage group, respectively. There were significant differences in the operation time and intraoperative volume of blood loss among the 3 groups (F=7.471, 6.037, P<0.05). There was no significant difference in the duration of hospital stay and 1year EWL among the 3 groups (F=1.439, 2.296, P>0.05). All the patients were followed up. Nineteen patients with sleep apnea had complete remission of symptoms at postoperative month 3. Twentyone patients with polycystic ovary syndrome had remission of symptoms after operations. Of 27 patients with type 2 diabetes mellitus, 25 patients had remission of symptoms at postoperative year 1 and 2 patients had improvement of symptoms. Fiftyseven of 79 patients with lipid metabolism disorders returned to normal at postoperative year 1. One hundred and twelve patients with fatty liver were improved after operation.
Conclusions:LSG is safe and feasible with a standardized operative procedure. Wholelayer suture may be prevent the leakage and no placement of gastric tube and drainage tube after operation can reduce the incidence of complications.