Our 1-year experience in laparoscopic sleeve gastrectomy.

Sleeve gastrectomy was conceived in 1988 both as a first step to the duodenal switch procedure and as an extension of anti-reflux surgery where patients lost significant weight. It is now a stand-alone laparoscopic bariatric procedure worldwide with two international consensus summits identifying it as a safe and feasible restrictive and appetite-suppressing procedure. In our centre, it is a key component in the surgical armamentarium and used as a first-line and revisional procedure for morbid obesity. The procedure is performed using standard five port technique. One year results are reviewed for its feasibility in our Asian patients. Twenty of 48 laparoscopic sleeve gastrectomies have a 1-year follow-up with four of them a revisional procedure for bands with complications. There were 11 males and 9 females (average age 43.6) and a representation of all four major ethnic groups. Average weight and BMI improved from 116.3 to 90.2 kg and 42.5 to 33.1 kg m(-2) after 1 year, respectively. Average weight loss was 26.1 kg and excess weight loss (in percent) was 49.6%. There was an improvement in diabetes mellitus, hypertension, obstructive sleep apnoea and asthma and three complications including two leaks and a gastro-oesophageal spasm/stricture. Laparoscopic sleeve gastrectomy is safe and feasible as first-line surgery for morbid obesity and revisional procedures for band-related complications in the short term. Further studies are required to elucidate the exact mechanisms of weight loss in the sleeve gastrectomy to answer the appropriateness of the variations in the technique and long-term weight loss and morbidity.

Laparoscopic repair of esophageal perforation due to Boerhaave syndrome.

Boerhaave syndrome is the spontaneous transmural rupture of the esophagus due to an increase in intraesophageal pressure when vomiting against a closed glottis. There are various methods of managing it, with the main principles of limiting sepsis, draining the area, and maintaining nutrition. These include conservative management, open repair with drain insertion, and laparoscopic repair, depending on the timing of presentation and the amount of sepsis. Although the gold standard is open thoracotomy and/or laparotomy, we present a case where an esophageal rupture, presenting within 24 hours and hemodynamically stable, was managed with laparoscopic repair and drain insertion with good results. There is a paucity of literature regarding this mode of management and we have discussed the various options available in literature. We conclude that this is a safe and viable option in the management of Boerhaave syndrome in a nonseptic patient presenting early.