Laparoscopic sleeve gastrectomy for morbid obesity with natural orifice specimen extraction (NOSE)

Abstract

OBJECTIVE: An experience with laparoscopic sleeve gastrectomy using the natural orifi ce specimen extraction (NOSE) technique. BACKGROUND: Bariatric surgery is nowadays the only long term effective obesity treatment method. METHODS: Twenty one consecutive patients underwent laparoscopic sleeve gastrectomy with the use of natural orifi ce specimen extraction (NOSE) in the Surgical Clinic of Faculty Hospital Ostrava between May 2012 and August 2012. Inclusion criteria were the body mass index (BMI) higher than 35 kg/m 2 or higher than 32 kg/m 2 accompanied with relevant comorbidities. RESULTS: Among 21 patients in this series, there were three men (14.3 %) and 18 women (85.7 %). Their mean age was 40.9 ± 10.2 years. Their mean preoperative BMI was 40.4 ± 4.6 kg/m 2 . No patient had previous bariatric surgery, one patient had laparoscopic fundoplication. All operations were completed laparoscopically with no conversions to an open procedure. In two cases, laparoscopic cholecystectomy was performed and the gallbladder was extracted along with the gastric specimen by transgastric approach. CONCLUSION: Laparoscopic sleeve gastrectomy is a safe and effective bariatric procedure with low morbidity and mortality. Based on our initial experiences it could be an indication for NOSE with transgastric approach. Obese patients would benefi t from this approach due to the elimination of wound complications (Tab. 2, Fig. 3, Ref. 22). Text in PDF www.elis.sk. KEY WORDS: laparoscopic sleeve gastrectomy-morbid obesity-bariatric surgery-natural orifi ce specimen extraction

Comparison of Stapled and Hand-Sewn Sleeve Gastrectomy

“…We were able to find only one study that remove sleeve gastrectomy specimen transorally. Gunkova et al removed sleeve gastrectomy specimen transorally in 21 patients with the aim of decreased risk of wound related complications [7]. In our cases that we did not use staplers, opening of the stomach gave us the oppurtunity to extract the specimen through the esophagus and mouth by endoscopy.…”

A Simple and Safe Technique in Extracting Specimen after Sleeve Gastrectomy

“…In order to reduce trocar-related complications after the sleeve gastrectomy, a technique involving a small number of patients with which the specimen was extracted transgastrically has been described. 13 However, this technique requires laparoscopic and endoscopic experience, and the risk of intraabdominal spread of stomach contents is the most important disadvantage.…”

Transvaginal Specimen Extraction After Laparoscopic Gastrectomy for Tumors

“…The transurethral approach was only suitable for urological surgeries and only for very small specimens. Extraction of a gastrectomy specimen through the transoral way, in other words, the transesophageal way, had been described in 2015 10. In that study, the specimens belonged to morbidly obese patients and there were no tumors in the specimens.…”