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Open Bariatric Surgery Scar

Dure to ensure adequate blood supply. In a total laparoscopic approach subtle ischemia may not be apparent on the monitor. Hand-assisted gastric bypass may have an improved cosmetic advantage when compared to open gastric bypass. This is especially true in a patient with an umbilical or supra-umbilical hernia that would need an incision starting at the xiphoid and going down to the umbilicus in open gastric bypass surgery. In analysis of the prospective data collected on 25 hand-assisted...

Contents

Indications and Patient Selection for Bariatric Rifat Latifi, Eric J. DeMaria and Harvey J. Sugerman 3 Pathophysiology of Morbid Obesity 3 Indications for Surgical Treatment of Morbid Effects of Weight Loss What Can the Patient 3. Laparoscopic Instruments for Bariatric Surgery 9 9 Hand Instruments Retractors, Graspers, Dissector 16 4. State of the Art Endosuite for Minimal Access Basic Philosophy of the MIS The Design The The The 5. Effects of Increased Intra-Abdominal Pressure on Laparoscopic...

Laparoscopic RouxenY Gastric Bypass Detailed Technical Issues

Laparoscopic Roux-en-Y gastric bypass is one of the most difficult and challenging laparoscopic procedures routinely performed today. It requires advanced skills and knowledge of both the fields of bariatric surgery and laparoscopy, familiarity with both short and long term follow-up of patients, as well as early postoperative technical and delayed long-term nutritional and metabolic complications. Those issues will be discussed in other chapters. The topic of this chapter is to provide a...

Laparoscopic Adjustable Silicone Gastric Banding

Lap Band Journal

DeMaria and Rifat Latifi Background Gastric banding has been promoted as a treatment for obesity by many surgeons over recent decades. Advantages included technical ease of performing the procedure and no intestinal anastomosis with the added risks of anastomotic leak. The most popular banding procedure is the vertical-banded gastroplasty, however this involves creation of a gastric staple line with risks of staple line disruption. Gastric banding involves creating a gastric pouch by...

Effects of Increased Intra Abdominal Pressure on Laparoscopic Surgery in Severe Obesity

Laparoscopic surgery has become very popular for the treatment of severe obesity. Obesity can be distributed in either an android fashion, primarily within the abdominal area or centrally as seen primarily in male patients, or in a gynoid manner, in the hips and buttocks, peripherally as seen primarily in female patients. Many of our severely obese female patients have both peripheral and central obesity. We have found that central obesity is associated with a significant increase in...

Hand Assisted Laparoscopic RouxenY Gastric Bypass

DeMaria While hand-assisted techniques have been shunned by some in the laparoscopic community, what better population to whom to apply it than the morbidly obese where conventional laparoscopic instruments may fall short. The total laparoscopic technique is difficult to learn and requires a very skilled endoscopic surgeon along with an assistant who is also well-trained in advanced laparoscopic techniques. The tactile sensation returned with hand-assisted...

Gastric Bypass Complications

Six additional patients have persistent severe obesity BMI gt 35 at least two years post-op, but either refuse further surgery or are satisfied with the results. Overall only four patients 11 in our series achieved BMI lt 35 and or at least 50 reduction in excess weight without complications. Two patients without complications have lost 79 and 85 of excess weight, where they remain at 113 and 117 of ideal weight, respectively. The overall need for band removal conversion to GBP in our series...

RouxenY Gastric Bypass

Since the advent of laparoscopic Roux-en-Y gastric bypass by Wittgrove et al, in 1993, the operation has generally been accorded high marks as to feasibility, when performed by skilled laparoscopic surgeons, and as to weight loss, when compared with the original operation performed using conventional open surgical techniques. Early series suggest that some improvement in the risk for wound complications infection and hernia may be possible on the other hand, there may be a higher risk of...

Endo Gia Stapler

Endo Gia Stapler

Endo GIA Universal Stapling System. Fig. 3.19. Endo GIA Universal Stapling System. surgical staplers have been the technological driving force in LGB. An important advance in this area has been the introduction of smaller staples, 2.0mm, for many vascular applications. The vascular staplers with 2.5mm staples were originally designed for large dissected vessels such as pulmonary vessels. The need for vascular staples in LGB is far different. Vessels encountered in the division of...

Laparoscopic Vertical Banded Gastroplasty

Horizontal Gastroplasty

DeMaria Introduction The evolution of morbid obesity surgery has been directed by an effort to minimize complications while improving weight loss and reducing obesity comorbidities. Two different types of procedures have developed, simple and complex. Simple procedures include all restrictive procedures like the horizontal gastroplasty HG , the vertical banded gastroplasty VBG , or the adjustable ring gastroplasty. Complex procedures entail those that bypass...

Laparoscopic Instruments for Bariatric Surgery

Laparoscopic Suture Passer

Laparoscopic gastric bypass LGB has developed in recent years due to close collaboration between physicians and the technology manufacturers. Close relationships with surgeons have allowed our industry to recognize the emergence of this procedure, and start to develop technologies that help make a LGB a safe, effective option for a challenging patient population. This chapter will discuss the instruments and technology currently used by many surgeons to perform LGB. The examples presented are...

Lap Band Contrast Studies

Herniated Lap Band

The Lap-Band device positioned around the proximal stomach. Fig. 7.2. The Lap-Band device positioned around the proximal stomach. rectus sheath at this site using nonabsorbable sutures with open surgical technique. We close all large port site. The skin wounds are irrigated, local anesthetic solution injected for postoperative analgesia, and closed. No intraperitoneal drains are left. Fig. 7.3. The Lap-Band secured anteriorly with 3-4 gastro-gastric sutures to prevent gastric...

Dilated Pouch Gastric Bypass

Esophageal Dilation Gastric Banding

Radiograph demonstrating normal positioning of the Lap-Band device. Fig. 7.4. Radiograph demonstrating normal positioning of the Lap-Band device. Other patients with dilatation are being followed by interval contrast radiography to assess for regression or possible progression of the esophageal dilatation as they do not desire surgery and or feel their weight loss is adequate. Esophageal dysmotility and dilation is a newly recognized complication of LASGB. Intuitively, one might...

Laparoscopic Gastric Bypass Clinical Outcomes

DeMaria Introduction In 1993, Wittgrove and Clark performed the first laparoscopic gastric bypass. This was soon followed by a published report in 1994 of their initial five cases outlining the technical feasibility of the operation.1 Since that time variations in operative technique have been described, the majority of which differ in the type of gastrojejunal anastomosis created. Regardless of the laparoscopic technique used during the procedure, the questions...