TECHNICAL STANDARDIZATION OF LAPAROSCOPIC VERTICAL GASTRECTOMY (SLEEVE GASTRECTOMY) (Atena Editora)

Abstract

Morbid Obesity is considered a current epidemic by the World Obesity Federation. It is related to a series of comorbidities, and therefore it is important to adopt an adequate treatment to reduce the deleterious effects on the individual's health. The laparoscopic sleeve gastrectomy (LSG) technique, known as gastric sleeve, has been shown to be advantageous when compared to other surgical techniques. However, there are several technical details that are not a consensus among surgeons, in addition to additional measures that aim to prevent the main complications in the postoperative period. Objective: to develop a standardization in the surgical technique and postoperative follow-up aimed at reducing complications and minimizing pain. Methods: Detailed technical systematization that involves: The preparation and positioning of the patient; as the ideal method of securing the patient to the operating table, positioning the table and passing the trocars to improve surgical ergonomics. The details of the operative technique; such as the calibration of the gastric tube with the fouchet probe, Downsizing of loads for stapling the gastric tube, reinforcement of the staple line with continuous suture with fixation of the omentum and the final test with methylene blue. In addition to additional measures such as; Analgesia by videolaparoscopic tap-block and infusion of intraperitoneal analgesic solution, thromboembolic prophylaxis with the use of elastic stockings and use of prophylactic Clexane intraoperatively. Results: During 21 months, 202 patients who underwent GVL were included according to the technique described here. Conclusion: The proposed surgical technique facilitates the surgical procedure, improves the surgeon's ergonomics, reduces bleeding rates and fistulas, reduces the need for postoperative analgesics and reduces thromboembolic complications when compared to the literature.