There is no reason to believe, at this point, that reduction in leak rates occur because reinforcement is used. Because the leak rate is small, the routine reinforcement of the staple line after sleeve gastrectomy is questionable at best, although a decrease in hemorrhage has been reported.

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Chronic postoperative inguinal pain syndromes are potentially debilitating sequelae following elective inguinal hernia repair. Diagnosis and definitive treatment constitute challenging issues for both the surgeon and the patient. In this prospective trial, we evaluated the impact of elective iliohypogastric and ilioinguinal nerve resection on the incidence of pain, numbness, and sensory loss following anterior, "tension-free" herniorrhaphy. One hundred ninety-one patients were enrolled and were reviewed 1 month, 6 months, and 1 year postoperatively. Pain, numbness, or any loss of sensation were recorded and categorized on a "mild," "moderate," or "severe" scale. No persistent pain syndrome was encountered. Numbness was found in 9.42% of the patients at the first month and in 6.28% of the patients after 1 year. Sensation loss (1.04%) was never bothersome or incapacitating at the end of the follow-up period. Elective neurectomy is safe to perform, well tolerated by patients, and is not associated with chronic postoperative inguinal pain.

OBJECTIVE: To evaluate the efficacy of Laparoscopic Sleeve Gastrectomy (LSG) as a definitive procedure for morbidly obese patients. DESIGN: This constitutes a prospective study carried out in a tertiary care private hospital and included 15 morbidly obese patients who underwent LSG. The operation was performed through two 12 mm and two 5 mm ports, using the Endo-GIA stapler to create a lesser curve gastric tube over a 36-Fr bougie. RESULTS: Operative time, complication rates, hospital length of stay, Body Mass Index (BMI), % of Excess Weight Loss (EWL) and appetite were evaluated. There were six females and nine males, aged (mean±SD) 40.5±10.5 yrs and preoperative BMI 47.8±7.5 kg/m². The operative time was 147.7±43.2 min. There was one conversion to open surgery and one gastric leak with haemorrhage that led to gastric tube stenosis, ultimately requiring revision surgery. All patients, except these two, were discharged on the 2 nd postoperative day after an upper GI series and the initiation of a clear liquid diet. At the follow-up (7.5±4.4 months post operatively), the % EWL was 35.7±10.1. Eight patients who received regular postoperative dietician counselling at follow-up did better than the others who did not (% EWL 40.4±3.8 vs 30.2± 4.1, respectively). All patients reported significant loss of appetite. CONCLUSIONS: Although the number of patients is relatively small, the data of this study indicate that laparoscopic sleeve gastrectomy is effective in weight reduction, being an acceptable surgical option for morbidly obese patients. A higher number of patients and longer follow-up period will be necessary to evaluate long-term efficacy.