gms | German Medical Science

Introduction: Laparoscopic sleeve gastrectomy is currently the second most performed primary bariatric procedure for morbid obese patients, with good postoperative results and achieving adequate excess weight loss (EWL). Current techniques include a small laparotomy site for extraction of the specimen and use of 5 to 7 trocars, with occurrence of postoperative hernias. Our group is performing hybrid NOTES transvaginal sleeve gastrectomy since 2008. The evolution of the technique with standardization of operative steps is presented in our clinical series.

Material and methods: Transvaginal Hybrid NOTES Sleeve gastrectomy was applied in 38 female patients from 2008 to 2012, and prospectively documented. IRB aproval was obtained in 2007, and patients signed informed consent. BMI was a mean of 46.2 (41 to 52). Development of technical standartization included: 1. Early vaginal access for optic and retraction, 2. Insertion of 3 abdominal trocars under vaginal view; 3. Liberation of the greater curvature with ultrassonic energy; 4. Stapling sleeve gastrectomy including antrectomy over a 36Fr Bougie; 5. Systematic oversewing of the staple line with PDS 3.0 and drainage; and 6. Transvaginal extraction of the specimen without retrieval bag.

Results: All procedures were performed using transvaginal technique and 3 to 5 trocars, with no conversions to open surgery. Procedure time lasts from 90 to 160min (mean 112 min) with minimal operative blood loss. Intraoperative complications were 2 vaginal lacerations and one liver bleeding. There were no postoperative complications. Follow up on the patients for a minimum of 6 months showed adequate excess weight loss and no occurrence of dispareunia

Conclusion: Transvaginal Hybrid NOTES Sleeve gastrectomy is now performed in a standard technique, allowing a feasible and safe procedure. It has the potential advantage of reducing postoperative hernia sites and presenting good cosmetic result.