Technical problems in laparoscopic sleeve gastrectomy

Introduction: Laparoscopic sleeve gastrectomy has been used as an isolated bariatric operation since a few years ago. In October 2007 a consensus was established, acknowledging sleeve gastrectomy as a bariatric procedure.
Aim: To analyze technical difficulties occurring during the procedure, as well as intraoperative and early postoperative complications.
Material and methods: Between October 2006 and June 2009 in the Department of Surgery 331 such procedures were done. A standardized operating technique was used. Mean BMI of patients was 46.14 kg/m². Mean age was 49.2 years. Eighty-four men and 247 women were operated on. During the procedure, a 34 Fr tube was inserted into the stomach to ensure adequate diameter and volume reduction with 60 mm long green linear mechanical staplers. The staple line was enforced with additional continuous suture.
Results: In 1.2% of patients bleeding from the port incision that required additional action was seen, while 3.93% had bleeding from the staple line (requiring clipping in 3.32% and stitch in 0.6%). There were no splenic injuries. No conversions to open operation occurred. Patients were mobilized in the evening of the day of surgery (mean time from the operation 7 h). Three patients (0.9%) had suture failure in the cardia area diagnosed on the first day after operation. One of them was treated laparoscopically, the other two by laparotomy. There were two deaths: in one patient of sepsis after suture leakage and in the other of cardiac infarction on the 4th day after the operation.
Conclusions: Laparoscopic sleeve gastrectomy can be considered a safe method, and can be recommended as a method of surgical treatment for obesity.