Cagigas J C, Martino E, Ingelmo A, Hernandez-Estefania R, Gomez-Fleitas M, Escalante C F
Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain.
Obes Surg. 1999 Aug;9(4):407-9. doi: 10.1381/096089299765553034.
This report describes the technical details and an initial evaluation of laparoscopic vertical gastroplasty modified for morbid obesity. After a surgical experience in 150 patients with open vertical banded gastroplasty (Mason's procedure), it was decided to perform a modified banded vertical gastroplasty.
Six patients were treated by this laparoscopic approach in 1997-1998. All patients were women with a mean age of 28 years (range 20-46). The mean body weight was 128 kg (range 105-146), and the mean BMI was 42.7 kg/m2 (range 35.6-53.0). Four or five 10- or 12-mm trocars were used. For all the dissection we used atraumatic ultracision (harmonic scalpel). In this procedure the technique of laparoscopic gastroplasty is performed without a circular gastric window. During the operation, 3 omental openings were made and the vertical staple-line was constructed by using a 30-mm 3-row linear stapler twice, establishing the gastric pouch. The outflow stoma was reinforced by a Gore-Tex band and calibrated to have an internal diameter of 10-15 mm. The band was sutured to itself.
There were no deaths or complications. Operating time was 200 min (150-240). The nasogastric tube was removed at 1-2 days. The postoperative course was characterized by normal respiratory function and minimal pain in all cases. Patients were discharged 5-6 days after operation.
Our technique excluded the circular gastric window (i.e., "no-punch") technique in the development of an effective and simple laparoscopic procedure to treat morbid obesity.
本报告描述了针对病态肥胖改良的腹腔镜垂直胃成形术的技术细节及初步评估。在对150例患者进行开放式垂直捆扎胃成形术（梅森手术）的手术经验之后，决定实施改良的捆扎垂直胃成形术。
1997年至1998年，6例患者接受了这种腹腔镜手术方法治疗。所有患者均为女性，平均年龄28岁（范围20 - 46岁）。平均体重为128千克（范围105 - 146千克），平均体重指数为42.7千克/平方米（范围35.6 - 53.0）。使用了4或5个10毫米或12毫米的套管针。对于所有解剖操作，我们使用了无创伤超声刀（谐波手术刀）。在此手术中，腹腔镜胃成形术技术在不制作圆形胃窗的情况下进行。手术过程中，制作了3个网膜开口，并使用30毫米3排线性缝合器两次构建垂直吻合线，形成胃囊。流出道造口用戈尔特斯带加强，并校准使其内径为10 - 15毫米。带子自身缝合。
无死亡病例或并发症。手术时间为200分钟（150 - 240分钟）。术后1 - 2天拔除鼻胃管。所有病例术后呼吸功能正常，疼痛轻微。患者术后5 - 6天出院。
我们的技术在开发一种有效且简单的治疗病态肥胖的腹腔镜手术中排除了圆形胃窗（即“无打孔”）技术。
