Abstract
Introduction:
The laparoscopic sleeve gastrectomy (LSG) is actually indicated in a wide panel of pathological conditions, especially in super obese patients, often affected by fatty liver disease. 1 Bariatric surgery allows histological improvement of hepatic steatosis and fibrosis in patients affected by a nonalcoholic fatty liver disease nonalcoholic steatohepatitis (NASH) associated with morbid obesity. 2 –4 Furthermore, isolated experiences propose LSG as a model of portal devascularization in patients presenting morbid obesity associated with cirrhosis and portal hypertension. 5 Technically, the standard laparoscopic approach for LSG is done routinely with four to seven ports. The concept of port reduction is an interesting direction of progress.
Materials and Methods:
Feasibility and effectiveness of the reduced port sleeve gastrectomy (RPSG) are demonstrated. 6 We herein present a video of RPSG, realized in a young female, presenting a BMI of 57 kg/m2, liver cirrhosis, splenomegaly, portal hypertension, and thrombocytopenia, in the context of NASH syndrome.
Result:
Operative time was 75 min. No perioperative complications were observed. The patient leaves the hospital at the third postoperative day. At the fourth postoperative month, hepatic function was improved and an abdominal CT-scan showed a reduction of hepatosplenomegaly and no port-site hernia. At the ninth postoperative month, the patient presented a BMI of 37 kg/m2.
Discussion:
The Roux-en-Y gastric bypass is still the gold standard in the treatment of-morbid obesity complicated by NASH. Unfortunately, 15% of untreated NASH patients will develop hepatic cirrhosis within 10–15 years, 7 which could be considered as a relative contraindication to GB. This subtype of patients may benefit of an alternative restrictive bariatric procedure with a less invasive approach.
Conclusion:
RPSG is safe and reproducible; furthermore, it could lay better outcomes reducing the parietal trauma, avoiding potential complications such as port-site hernia, more frequent and deleterious in cirrhotic patients. 8
No competing financial interests exist.
Runtime of video: 4 mins 57 secs
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