Stapleless laparoscopic sleeve gastrectomy. Preliminary report

Background: Laparoscopic sleeve gastrectomy (SG) as a single-stage procedure for the treatment of morbid obesity is becoming increasingly popular. In undeveloped countries, the linear staples required to create the sleeve are not always available because of their high cost. As an alternative to the staples, the bipolar vessel sealer device could be used in bariatric surgery to divide and temporarily seal the stomach. Settings: Universidad Central de Venezuela, Caracas, Venezuela. Methods: Between May 2015 and July 2016, 9 patients with a mean body mass index of 38.2 kg/m(2) were submitted to a stapleless laparoscopic SG using the bipolar vessel sealer for the gastric division. The sleeve was performed over a 42 French bougie and closed with 2 layers of running sutures. Surgical time, morbidity, hospital stay, and excess weight loss were prospectively collected. Results: Mean operative time and hospital stay were 117 min and 2.3 days. There was no major morbidity but 2 patients presented a basal atelectasis, which was solved by medical treatment without consequences. After a mean follow up of 6.8 months the mean excess weight loss was 78.4%. Conclusion: The technique of stapleless laparoscopic SG presented in this report is a valid alternative when these devices are not available. Large series with long-term follow-up are necessary to make definitive conclusions. (C) 2017 American Society for Metabolic and Bariatric Surgery. All rights reserved.