When performed by 'technique-specific' surgeons, both LS and HS GJA in LRYGB may be performed safely with no significant differences in morbidity, reoperations, or EWL.

BACKGROUND The techniqueoflaparoscopiccholecystectomy still has areas requiring refinement, including complications of clips being dislodged. The use of the ultrasonically activated scalpelfor tissuecuttingand coagulation is apotential replacementfor electrosurgery, which can be related to differentc omplications. Theh armonic scalpel was previously used forthe divisionofthe cystic artery andliver-beddissection.Recent advancesinharmonicscalpel technology nowprovide safe division and closure of the cystic ductupto6mm in diameter. 1-5 TECHNIQUE This wasap rospective study of 22 patients undergoing laparoscopic cholecystectomy using the harmonic scalpel. The harmonic scalpelw as used as thes ole instrument for division of thec ysticduct and artery as well as dissection of the liverbed. Theaverage age of thep atientsw as 42.5 years (range, 22-61 years) with 5males and 17 females. Theaverage operation time was 34 min. Thea verage postoperative in-patient stay was 7.2h(all discharged on thesame day of surgery).Nopatientsdeveloped postoperative haemorrhage or bile leakage.

BackgroundA meta-analysis and six randomized controlled trials show higher 30-day complication rates with laparoscopic Roux-en-Y gastric bypass (LRYGB) than with laparoscopic sleeve gastrectomy (LSG).AimTo identify any difference in 30-day outcomes of patients treated with LRYGB or LSG when a standardized technique and identical post-operative protocol was followed with all procedures being conducted either by or under the supervision of a single consultant surgeon who had significant experience in bariatric surgery prior to commencing independent practice.MethodsA prospectively collected database of all patients under primary LRYGB or LSG, between March 2010 and February 2017, was analyzed. Data on demographics, length-of-stay (LOS), conversion to open, 30-day complications and mortality were reviewed.ResultsOver a seven-year period, 485 patients (LRYGB-279 and LSG-206) were included. There were no significant demographic differences and no difference in the pre-operative risk scoring [American Society of Anesthesiologists (ASA) and obesity surgery mortality risk score (OSMRS)] between the groups. There was no significant difference between the groups in terms of LOS (p = 0.275), complications (p = 0.920), re-admissions (p = 0.593) or re-operations (p = 0.366) within 30-days. There were no conversions to open or in-patient mortality in either group.ConclusionsUnlike previous studies, we found no difference in early complication rates between LRYGB and LSG in a comparable cohort when performed by a surgeon with sufficient experience in bariatric surgery.

Background and Objectives:Laparoscopic sleeve gastrectomy (LSG) has some unique complications, the most concerning of which is sleeve leak. Staple line reinforcement (SLR) has been suggested as a means of decreasing the risk of sleeve leak, but it increases the cost. However, there is little in the literature regarding the effect of standardized operative technique in reducing the complications and improving the outcomes in LSG. We sought to demonstrate that standardization of the operative procedure and perioperative care is the key to an excellent 30-day outcome and that SLR is not necessary to ensure a negligible staple line leak and bleeding rate.Methods:A prospectively maintained database was analyzed to identify 303 consecutive patients undergoing LSG between July 2010 and November 2017. Data on patient demographics, length of hospital stay, conversion to open surgery, perioperative complications, and mortality were analyzed. Standardized operative technique and postoperative protocol were followed in all cases. SLR was not used in any case.Results:Among 303 cases, there were 15 complications (5%), 5 (1.7%) of which were severe (Clavien-Dindo grade ≥3a). There were no conversions to open procedure, no staple line leaks, and no inpatient deaths in the cohort. No patient was readmitted with an early stricture.Conclusions:The use of a standardized operative and postoperative protocol led to an excellent early outcome in our LSG cases. Standardization may act to obviate the need for routine SLR techniques which are associated with a significant financial cost to both patient and hospital.