Morbid Obesity and Sleeve Gastrectomy: How Does It Work?

Laparoscopic sleeve gastrectomy is known to be a safe and effective procedure for treating morbid obesity and is performed with increasing frequency both in Europe and the USA. Despite its broad use, many questions about the remaining gastric tube diameter, its long-term efficacy, its effects on gastric emptying, and the hormones involved still remain to be answered. In order to use such a relatively new surgical procedure wisely, it is essential for every surgeon and physician to understand how sleeve gastrectomy acts in obesity and what its potential benefits on the patients’ metabolism are. This review focuses on the most important pathophysiologic questions referred to sleeve gastrectomy on the literature so far, in an attempt to evaluate the different issues still pending on the subject

Somatostatin versus octreotide in the treatment of patients with gastrointestinal and pancreatic fistulas

BACKGROUND AND PURPOSE: Gastrointestinal and pancreatic fistulas are characterized as serious complications following abdominal surgery, with a reported incidence of up to 27% and 46%, respectively. Fistula formation results in prolonged hospitalization, increased morbidity/mortality and increased treatment costs. Conservative and surgical approaches are both employed in the management of these fistulas. The purpose of the present study was to assess, evaluate and compare the potential clinical benefit and cost effectiveness of pharmacotherapy (somatostatin versus its analogue octreotide) versus conventional therapy

Gastritis might be considered as a technical factor affecting laparoscopic sleeve gastrectomy

There is a paucity of data regarding gastritis as a technical factor affecting the surgical technique. Antritis and gastritis usually cause stomach wall thickness which can interrupt stapler function or even can cause serosal tear during the dissection. We report a video presentation of laparoscopic sleeve gastrectomy in a morbidly obese patient with antritis. Choosing black cartridge for patients with Helicobacter pylori gastritis might be the optimal technique for division of the antrum in laparoscopic sleeve gastrectomy. Further studies are required to clarify this parameter

Prospective comparative study of the efficacy of staple-line reinforcement in laparoscopic sleeve gastrectomy

Background Staple-line reinforcement has been used with promising results in laparoscopic gastric bypass in order to reduce leakage, increase staple-line integrity, and diminish staple-site bleeding. The purpose of this study was to determine if staple-line reinforcement with bovine pericardial strips reduces surgical complications of laparoscopic sleeve gastrectomy (LSG). Methods This is a prospective comparative study of all patients who underwent LSG by a standard operative team in an 18-month period. Patients were enrolled in group A if they received staple-line reinforcement and in group B when not. The staple line was reinforced with bovine pericardium strips [Peri-Strips Dry (R) (PSD)]. Results In total, 187 patients, with a median preoperative BMI of 45.3 kg/m(2) (range = 35.1-72.7), underwent LSG. Ninety-six patients were enrolled in group A and 91 in group B; the two groups were comparable in their various characteristics. Morbidity rate representing grade III-IV surgical complications reached 7.4% and mortality rate was 0.5%. Reinforcement with PSD significantly reduced the occurrence of bleeding from the staple line and intra-abdominal collections (P = 0.012 and 0.026). The leak rate was not significantly reduced in group A. Patients in group A required fewer days of hospitalization. Conclusions Reinforcement of the staple line in LSG resulted in significantly fewer surgical complications compared to standard stapling of the gastric tube. The additional cost due to the reinforcement of the staple line may be counterbalanced by the reduction in the length of hospitalization

Kisspeptin and the Genetic Obesity Interactome.

Background: Kisspeptin (encoded by the KISS1 gene in humans) is an excitatory neuromodulatory peptide implicated in multiple homeostatic systems, including anti--oxidation, glucose homeostasis, nutrition, locomotion, etc. Therefore, in the current obesity epidemic, kisspeptin is gaining increasing interest as a research objective. Aim: To construct an updated interactome of genetic obesity, including the kisspeptin signal transduction pathway. Methods: Kisspeptin and obesity-related genes or gene products were extracted from the biomedical literature, and a network of functional associations was created. Results: The generated network contains 101 nodes corresponding to gene/gene products with known and/or predicted interactions. In this interactome, KISS1 and KISS1R are connected directly to the luteinizing hormone receptor (LHCGR), gonadotropin-releasing hormone receptor (GNRH1), and indirectly, through the latter, to proopiomelanocortin (POMC), glucagon, leptin (LEP), and/or pro-protein convertase subtilisin/kexin-type 1 (PCSK1), all of which are critically implicated in obesity disorders. Conclusions: Our updated obesidome includes kisspeptin and its connections to the genetic obesity signalosome with 12 major hubs: glucagon (GCG), insulin (INS), arginine vasopressin (AVP), G protein subunit beta 1 (GNB1) and proopiomelanocortin (POMC), melanocortin 4 receptor (MC4R), leptin (LEP), gonadotropin-releasing hormone 1 (GNRH1), adrenoceptor beta 2 and 3 (ADRB2-3), glucagon-like peptide 1 receptor (GLP1R), and melanocortin 3 receptor (MC3R) genes were identified as major "hubs" for genetic obesity, providing novel insight into the body's energy homeostasis

Complete endoscopic axillary lymph node dissection without liposuction for breast cancer: Initial experience and mid-term outcome

Aim: To present our initial experience with complete endoscopic axillary lymph node dissection (EALND) in 4 breast cancer patients with respect to feasibility, safety, and clinical outcome. Patients and Methods: Between January 2003 and March 2004, 4 women consented to be treated with lumpectomy followed by complete (level I, II, and III) EALND without liposuction, at the Laparoendoscopic Unit of Athens Medical School. All 4 patients presented with a solitary breast cancer lesion smaller than 2 cm in diameter and a negative clinical and sonographic lymph node status (< 1 cm). Results: All the operations were completed endoscopically in less than 70 minutes (44 to 69 min). The axillary lymph node harvest ranged between 12 and 21 nodes. No lymphedema, motor nerve damage, seroma formation, or wound complications were observed. Prolonged hospitalization, owing to persistent lymphorrhoea was required for 1 patient. During a mean follow-up of 21.3 months, 2 patients reported mild hypoesthesia-paresthesia along the upper medial part of the respective arm, whereas no tumor recurrences were documented. Conclusions: Although partial EALND has not been established as the treatment of choice for axillary management, complete EALND seems to be a feasible and effective minimally invasive treatment modality, which could be safely applied in patients with positive sentinel node biopsy, treated in specialized centers