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LAPAROSCOPIC SLEEVE GASTRECTOMY Controversies C

LAPAROSCOPIC SLEEVE GASTRECTOMY Controversies C. Dr. G. SURESH CHANDRA HARI M.S FICS FAIS FMAS SIGMA HOSPITALS-SECUNDERABAD. WHO SHOULD HAVE A SLEEVE. Ist STAGE OF VERY HIGH B.M.I SEVERE HEART DISEASE SEVERE LUNG DISEASE VERY HIGH RISK CASES

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LAPAROSCOPIC SLEEVE GASTRECTOMY Controversies C

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  1. LAPAROSCOPICSLEEVE GASTRECTOMYControversiesC Dr. G. SURESH CHANDRA HARI M.S FICS FAIS FMAS SIGMA HOSPITALS-SECUNDERABAD

  2. WHO SHOULD HAVE A SLEEVE Ist STAGE OF VERY HIGH B.M.I SEVERE HEART DISEASE SEVERE LUNG DISEASE VERY HIGH RISK CASES IN O.T, LARGE LIVER. BOWEL ADHESIONS LOW B.M.I

  3. WHERE TO START SLEEVING

  4. WHAT SIZE OF BOUGIE • 29 to 48 FRENCH WERE USED • 34 • 32 • EACH FRENCH IS 0.33 cms

  5. QUANTITY OF STOMACH • 40 – 60 ml • 60 – 80 ml • About 100 ml • 500 – 1000 ml ( mean 764 ml ) • 150 – 160 ml

  6. WHAT STAPLES - STAPLER • BLUE - GREEN - GOLD • ARTICULATING – STRAIGHT

  7. REINFORCEMENT OF STAPLE LINE • USE OF SEAMGUARD • SUTURING – • SUTURE MATERIAL ? DECREASED P.O LEAK RATES / BLEEDING RISK OF STENOSIS / BLEEDING

  8. PER OPERATIVE / P.O LEAK TEST

  9. CURRENT SCENARIO • 1. “How do clinical efficacy outcomes of LSG compare to other bariatric procedures? • No conclusions are currently possible regarding the comparative clinical efficacy of LSG because of the very small quantity of data, much of which came from small, low-quality studies. • An insufficient amount of evidence for each comparison was available to reach conclusions about how the effectiveness of LSG compares to other bariatric procedures.” • 2. “How do perioperative outcomes of LSG compare to other bariatric procedures? • An insufficient amount of evidence for each comparison was available to reach conclusions about how perioperative outcomes associated with LSG compare to other bariatric procedures.”

  10. 3. “How do AE [adverse event] rates for LSG compare to those of other bariatric procedures? • No conclusions can be drawn regarding comparative safety because so few studies reported the same AEs.” • 4. “What AEs were reported for LSG? • The overall mortality rate was 0.9 percent for super obese patients and 0.2 percent for morbidly obese patients (including one suicide). The proportion of patients requiring reoperation for any reason was 3.5 percent in the super obese group and 2.3 percent in the morbidly obese group. The most common AE was leaking, which most frequently occurred perioperatively. However, at less than 2 percent, the rate was low.  The other AEs occurred at rates of less than 1 percent overall.  Super obese patients had several instances of serious events that were not reported in the lower BMI patients, such as need for ventilator support or development of renal failure.”

  11. THANK YOU

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