Gastrectomía en manga transumbilical con técnica simplificada: técnica y resultados quirúrgicos en 100 pacientes

Abstract

Simplifi ed transumbilical sleeve gastrectomy. Technique and surgical results in 100 patientsBackground: The use of transumbilical approach for sleeve gastrectomy has been recently reported, using different technique variations. Aim: To report the technique and surgical results of a transumbilical approach simplifi ed sleeve gastrectomy, using rigid instruments. Material and Methods: Ninety four women and six men, selected by a multidisciplinary team, underwent transumbilical sleeve gastrectomy. The operative technique involved a transumbilical incision, introduction of a SILS ® or GelPoint ® multiport, and a 5mm metallic accessory trocar laterally in the left fl ank. Rigid instruments were used in all patients. The greater curvature was dissected from 4-5 cm above the pylorus to the angle of His. Gastric transection was completed with a stapler, and calibrated with a 36 French tube advanced through the pylorus. Hemostasis of the staple line was carried out with metallic clips. A barium swallow was performed in ten randomly chosen patients, confi rming the correct tubular shape of the stomach. Results: Body mass index of operated patients ranged from 30 to 43 kg/m 2 . Mean operative time was 56.4 ± 16.7 minutes. During the early postoperative period, two patients had a hemoperitoneum, one had an antral leak and one had an intestinal perforation. No conversion to conventional laparoscopy or open technique was required. No patient died. The mean length of hospital stay was 2.3 ± 0.5 days. The cosmetic result was satisfactory for all patients. Conclusions: Transumbilical sleeve gastrectomy is a safe and feasible procedure with the reported technique. The insertion of an accessory 5mm trocar in the left fl ank simplifi es the procedure, allowing the use of rigid instruments.