Vasileios Drakopoulos
Evangelismos General Hospital, Greece
Title: Three-port Laparoscopic Sleeve Gastrectomy for Morbid Obesity: Our experience
Biography
Biography: Vasileios Drakopoulos
Abstract
Sleeve gastrectomy is traditionally performed with the aid of 5 to 7 abdominal trocars. We aim to present our experience concerning laparoscopic sleeve gastrectomy for morbid obesity, with a more minimal invasive approach, using three ports- trocars. Laparoscopic Sleeve Gastrectomy (LSG) is traditionally performed using 5 to 7 abdominal trocars. By reducing the number of trocars, parietal trauma, pain and hernia risks can be minimized.We present our 3-year experience concerning LSG for morbid obesity using three trocars, with emphasis on a simple suture-based trocar-free liver retractor. Methods: We retrospectively analyzed 65 patients who underwent LSG for morbid obesity, from May 2014 to December 2016. Three trocars are typically used: one 10-mm periumbilical optical trocar and two 12-mm trocars on the midclavicular lines. A suture is percutaneously inserted and fixed to the right crus of the diaphragm. Careful traction lifts the left hepatic lobe offering better surgical field and access to the gastroesophageal junction. A gauze is used to protect liver parenchyma from possible injury. Furthermore, sectioning and stapling of the stomach is performed before the gastroepiploic division, reducing the need of another left sided trocar. Results: All the patients had an uncomplicated recovery. No liver injury or wound problem was mentioned. Conclusions: The placement of a suture at the right crus of the diaphragm can reduce the number of trocars, leading to less postoperative pain, risk of hernia and better cosmetic outcome without compromising the safety of the operation or the rate of postoperative complications.