Sleeve gastrectomy with wrapping using polytetrafluoroethylene to prevent gastric enlargement in a porcine model.

Abstract

BACKGROUND:

The safety and efficacy of laparoscopic sleeve gastrectomy followed by biliopancreatic diversion with duodenal switch for morbid obesity has been well established. We previously recommended 2-stage laparoscopic biliopancreatic diversion with duodenal switch for super-super obese patients. In the 2-stage version, these patients undergo laparoscopic sleeve gastrectomy as a first-stage procedure, followed by laparoscopic biliopancreatic diversion with duodenal switch as the second stage for more definitive treatment of their obesity. However, short-term weight regain may occur owing to gastric dilation after initial laparoscopic sleeve gastrectomy. The aim of this study was to prevent gastric dilation after sleeve gastrectomy. We designed a sleeve gastrectomy with wrapping using polytetrafluoroethylene dual mesh.

METHODS:

Eleven Yorkshire pigs weighing 20-25 kg underwent sleeve gastrectomy with wrapping using polytetrafluoroethylene dual mesh (wrapping group) or sleeve gastrectomy only (control group) to compare the weight loss. The animals were weighed weekly postoperatively. Necropsy was performed 8 weeks postoperatively to confirm the wrapping by pathologic report.

RESULTS:

Four pigs died because of staple line failure or strangulation; no perioperative complications occurred in the other pigs. The operative time for the control group was 198 +/- 60 minutes and for the wrapping group was 181 +/- 86 minutes (P = NS). The average weight of the removed stomach was 123.3 +/- 5.8 g in the control group and 140.3 +/- 69.9 g in the wrapping group (P = NS). The postoperative weight gain at 8 weeks was significantly slower in the wrapping group than in the control group (P <.0001). The pathologic necropsy report noted that the mesh was well attached to the stomach wall at 9 days postoperatively, with no unexpected deaths.

CONCLUSION:

Sleeve gastrectomy with wrapping using polytetrafluoroethylene dual mesh is feasible, and weight gain was reduced in the porcine model.

• Authors: Kazuki Ueda, Michel Gagner, Luca Milone, Sergio J Bardaro, Ke Gong
• Journal: Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery (Surg Obes Relat Dis) 2008 Mar-Apr Vol. 4 Issue 2 Pg. 84-90 ISSN: 1550-7289 [Print] United States
• PMID: 17400032 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Polytetrafluoroethylene

Topics

• Analysis of Variance
• Animals
• Dilatation, Pathologic (prevention & control)
• Gastrectomy (methods)
• Laparoscopy
• Models, Animal
• Obesity, Morbid (surgery)
• Pilot Projects
• Polytetrafluoroethylene
• Surgical Mesh
• Swine