Impact of Laparoscopic Sleeve Gastrectomy on Gastrointestinal Motility.

OBJECTIVE: Laparoscopic sleeve gastrectomy (LSG) was considered mainly as a restrictive procedure due to anatomic alterations in the upper gastrointestinal tract. Additionally, due to neurohormonal alterations, LSG modifies the gastrointestinal motility, which controls appetite and feeling of satiety. AIM: The aim of the study was to review the impact of laparoscopic sleeve gastrectomy on gastrointestinal motility. MATERIAL AND METHODS: A search of the medical literature was undertaken in Pubmed, Web of Science, and Cochrane library. Esophageal, gastric, bowel motility were assessed separately. RESULTS: Nine studies assessed esophageal motility. The data remain debatable attributing to the heterogeneity of follow-up timing, surgical technique, bougie size, and distance from pylorus. The stomach motility was assessed in eighteen studies. Functionally, the sleeve was divided into a passive sleeve and an accelerated antrum. All scintigraphic studies revealed accelerated gastric emptying after LSG except of one. Patients demonstrated a rapid gastroduodenal transit time. The resection of the gastric pacemaker had as a consequence aberrant distal ectopic pacemaking or bioelectrical quiescence after LSG. The bowel motility was the least studied. Small bowel transit time was reduced; opposite to that the initiation of cecal filling and the ileocecal valve transit was delayed. CONCLUSION: Laparoscopic sleeve gastrectomy has impacts on gastrointestinal motility. The data remain debatable for esophageal motility. Stomach and small bowel motility were accelerated, while the initiation of cecal filling and the ileocecal valve transit was delayed. Further pathophysiological studies are needed to evaluate the correlation of motility data with clinical symptoms.

Esophageal motility after laparoscopic sleeve gastrectomy.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) modifies the upper gastrointestinal tract motility. Controversial data currently exist. The aim of the study was to evaluate esophageal motility before and after LSG. PATIENTS AND METHODS: Morbid obese patients scheduled for LSG underwent reflux symptoms evaluation and manometry preoperatively and postoperatively. The preoperative and postoperative results were compared and analyzed. RESULTS: Eighteen patients were enrolled. Heartburn and regurgitation improved in 38.9% and 11.1% of the patients, but deteriorated in 11.1% and 27.8% of the patients, respectively. Lower esophageal sphincter (LES) total length decreased postoperatively (p=0.002). Resting and residual pressures tended to decrease postoperatively (mean difference [95% confidence interval]: -4 [-8.3/0.2] mmHg, p=0.060; -1.4 [-3/0.1] mmHg, p=0.071, respectively). Amplitude pressure decreased from 95.7±37.3 to 69.8±26.3 mmHg at the upper border of LES (p=0.014), and tended to decrease at the distal esophagus from 128.5±30.1 to 112.1±35.4 mmHg (p=0.06) and mid-esophagus from 72.7±34.5 to 49.4±16.7 mmHg (p=0.006). Peristaltic normal swallow percentage increased from 47.2±36.8 to 82.8±28% (p=0.003). Postoperative regurgitation was strongly negatively correlated with LES total length (Spearman's r=-0.670). When groups were compared according to heartburn status, statistical significance was observed between the groups of improvement and deterioration regarding postoperative residual pressure and postoperative relaxation (p<0.002, p<0.002, respectively). With regard to regurgitation status, there was statistically significant difference between groups regarding preoperative amplitude pressure at the upper border of LES (p<0.056). CONCLUSION: Patients developed decreased LES length and weakened LES pressure after LSG. Esophageal body peristalsis was also affected in terms of decreased amplitude pressure, especially at the upper border of LES. Nevertheless, body peristalsis was normalized postoperatively. LSG might not deteriorate heartburn. Regurgitation might increase following LSG due to shortening of LES length, particularly in patients with range of preoperative amplitude pressure at the upper border of LES of 38.9-92.6 mmHg.

The role of the platelet-rich plasma in accelerating the wound-healing process and recovery in patients being operated for pilonidal sinus disease: preliminary results.

BACKGROUND: Because of the poor quality of life that results from the open technique (open excision and packing) for surgically treating pilonidal cyst disease, several alternatives that accelerate the wound-healing process have been proposed. This study aimed to evaluate the effect of platelet-derived growth factors on the healing process. METHODS: Fifty-two patients with pilonidal sinus disease who underwent open excision and secondary closure of the surgical wound (n = 22) or additional local postoperative infusion of platelet-derived growth factors (n = 30) were evaluated. Duration of total wound healing and time to return to normal activities were evaluated. Quality of life of patients in each group was assessed via a stabilized questionnaire. RESULTS: Wound-healing rates were much greater for the platelet group (p < 0.01). Complete healing of the surgical wound required 24 days for the platelet group while the respective time for the control group was more than 30 days (p < 0.01). Patients in the platelet group returned to their normal activities around the postoperative day 17 when mean wound volume was about 10 cc, while control group patients managed to do so around the postoperative day 25. CONCLUSIONS: These data provide evidence that the use of platelet-derived growth factors directly to the surgical wound enhances the healing process resulting in faster recovery of patients surgically treated for pilonidal sinus disease.

Radiofrequency-assisted partial splenectomy: Histopathological and immunological assessment of the splenic remnant in a porcine model.

BACKGROUND: Radiofrequency (RF) ablation has recently been expanded from palliative treatment into tissue-preserving surgery with controversial results. RF has been accused of septic complications and dysfunction of the target organ due to uncontrolled energy distribution. The aim of this study was to evaluate the short- and long-term implications of RF energy to the remaining splenic tissue after laparoscopic and open RF-assisted partial splenectomy. METHODS: Thirty pigs randomly underwent laparoscopic RF partial splenectomy (n = 10), open RF partial splenectomy (n = 10) using the Radionics Cooltip radiofrequency system (Tyco Hellas), while a third group (n = 10) underwent the conventional procedure. Intraoperative parameters were recorded. Complete blood counts, along with splenic function tests, were estimated preoperatively, immediately postoperatively, and at 1 and 6 months after the procedure. Histology was also evaluated. A separate group of five animals randomly undergo conventional resection (n = 2) and open RF resection (n = 3). These animals were sacrificed 1 month postoperatively and were used for histology only. RESULTS: The blood loss was minimal in both RF groups. No septic complications were observed throughout the follow-up period. Laboratory values at 1 month postoperatively showed decreased splenic function in both RF groups. Histology at 1 month was indicative of a chronic inflammatory reaction to the RF groups whereas, in the control group, prominent hypervascular granulated tissue was observed. Six months postoperatively, the platelet count remained elevated in the RF groups. Histology revealed intense fibrosis at the ablation site, as opposed to friable granulated tissue in the conventional group. CONCLUSIONS: Radiofrequency energy acts as an excellent haemostatic tool. The healing process shifts from the thermal injury to chronic inflammatory reaction and, 6 months later, to intense fibrosis as opposed to the hypervascular granulated tissue presented in the nonablated spleen. However, the longer the RF energy is applied, the more the splenic function is transiently affected.

Tissue preserving hepatectomy by a vessel sealing device.

BACKGROUND: The intraoperative blood loss and the biliary leak constitute the major causes of postoperative morbidity following liver resection. We describe a new technique for liver parenchyma transection using the Atlas modification of the ligasure vessel sealing system. The gradual closure of the instrument may cause crushing of the hepatic tissue and heat sealing of the vessels and bile ducts at the same time. MATERIALS AND METHODS: Ten cirrhotic patients (group A) underwent minor liver resections due to hepatocellular carcinoma (HCC). In four of these patients a bisegmentectomy was carried out, whereas in the remaining six the resection involved one segment. In addition, twelve patients with localized metastatic liver disease (group B) underwent tissue preserving hepatectomy also. Six of these patients underwent a bisegmentectomy and six had a local resection involving one segment. RESULTS: The blood loss in the first group varied from 120 to 350 ml, whereas in the second group varied from 80 to 280 ml. No postoperative biliary leakage was mentioned. CONCLUSION: This alternative technique of dividing the hepatic parenchyma seems to be simple and efficacious in preventing significant blood loss and bile leak in minor liver resections.