Ramya Kalaiselvan1, Basil J Ammori2. 1. Department of Upper Gastrointestinal Surgery, Salford Royal Hospital, Manchester, United Kingdom. 2. Department of Upper Gastrointestinal Surgery, Salford Royal Hospital, Manchester, United Kingdom; The University of Manchester, Manchester, United Kingdom. Electronic address: bammori@btinternet.com.
Abstract
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has become an established primary bariatric procedure. Gastric stenosis after LSG has been reported in a few studies and often occurs at the level of incisura or midbody because of a technical operative error and could be associated with a leak. This can be managed by endoscopic dilations or revision surgery. The objective of this study is to describe a novel technique to deal with sleeve stenosis and its outcome. METHODS: Two patients presented with sleeve stenosis after LSG and underwent a novel technique. The patients were followed up for 18 months. RESULTS: We describe a novel technique of laparoscopic median gastrectomy in 2 patients that involved resection of the stenotic segment followed by a hand-sewn, gastrogastric, end-to-end anastomosis. Both patients had successfully recovered from stenosis related symptoms, although one required an endoscopic dilation of the anastomosis. CONCLUSION: Laparoscopic median gastrectomy is a feasible and effective option in patients who have failed conservative management of stenosis after LSG and in whom there is a desire to avoid seromyotomy or conversion to gastric bypass.
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has become an established primary bariatric procedure. Gastric stenosis after LSG has been reported in a few studies and often occurs at the level of incisura or midbody because of a technical operative error and could be associated with a leak. This can be managed by endoscopic dilations or revision surgery. The objective of this study is to describe a novel technique to deal with sleeve stenosis and its outcome. METHODS: Two patients presented with sleeve stenosis after LSG and underwent a novel technique. The patients were followed up for 18 months. RESULTS: We describe a novel technique of laparoscopic median gastrectomy in 2 patients that involved resection of the stenotic segment followed by a hand-sewn, gastrogastric, end-to-end anastomosis. Both patients had successfully recovered from stenosis related symptoms, although one required an endoscopic dilation of the anastomosis. CONCLUSION: Laparoscopic median gastrectomy is a feasible and effective option in patients who have failed conservative management of stenosis after LSG and in whom there is a desire to avoid seromyotomy or conversion to gastric bypass.
Authors: Jad Farha; Lea Fayad; Ali Kadhim; Cem Şimşek; Dilhana S Badurdeen; Yervant Ichkhanian; Mohamad I Itani; Anthony N Kalloo; Mouen A Khashab; Vivek Kumbhari Journal: Obes Surg Date: 2019-07 Impact factor: 4.129