Title : Successful application of a new stapler with reinforcement installed to sleeve gastrectomy in bariatric surgery

Conventional laparoscopic Roux-en-Y gastric bypass (LRYGB) is gold standard for bariatric surgery, but the procedure requires five to seven incisions for placement of multiple trocars and thus may produce less-than-ideal cosmetic results. Recently, single-incision laparoscopic surgery (SILS) has been used for bariatric procedures, and this surgery is considered a type of minimally invasive surgery. When SILS is performed via the transumbilical route, the resultant abdominal wound is hidden and the cosmetic outcome is better.Here we present one of our cases of Single Incision transumbilical Roux en Y gastric bypass Surgery without usage of any commercially available single port systemsVideo:In this high Definition video, we show a single incision Laparoscopic Roux en Y gastric bypass.-Step 1 involves creating a transverse umbilical scar and raising umbilical flaps on either side-Four trocars (12mm, two 5mm and one 10mm) are inserted directly through the fascia at different sites after creating the pneumoperitoneum-the liver was retracted using a novel liver suspension technique of passing prolene suture through the liver and suspending the liver using gauze -The gastric pouch of 50ml is created in standard fashion using blue cartridges-the gastrocolic omentum is divided in the midline-the jejunum was divided at 75 cm and the jejuno-jejunostomy was done with 100cm Roux limb using linear staplers and intracorporeal sutures-The gastrojejunostomy was performed using 35mm liner staplers and the defect closed with 2-0 PDS with intracorporeal suturing Retrospective analysis from 99 Japanese cases of bariatric surgery at Chiba University Hospital. Research Center for Frontier Medical Engineering, Chiba University, Chiba, Japan Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan Department of Surgery, Shimotsuga General Hospital, Tochigi, Japan Hiroshi Kawahira,Isao Kawamura,Masaaki Kodama,Hideki Hayashi,Toshiyuki Natsume,Takashi Akai,Mikito Mori,Yukimasa Miyazawa,Hisahiro Matsubara Background: Since "classical-style" gastric bypass for morbid obesity has been performed in 1982, the first bariatric surgery in Japan, the number of obesity patients has been gradually increased. This is the retrospective analysis of the patient outcome at Chiba University Hospital, Japan. Patients & Methods: 99 patients have been operated for bariatric surgery in our department and our related hospital from 1982 though 2006. 31 males and 68 females were applied. The average age was 30.7 ± 9.8 years. 11 classical style gastric bypass, 69 gastroplasty (50 vertical banded gastroplasty, 8 horizontal banded gastroplasty, 11 other types), 17 Roux-Y gastric bypass, 1 sleeve gastrectomy and 1 sleeve gastrectomy with duodenal switch were performed in this study. Results: The body weight of each patients has been decreased favorably (figure). Among all surgery, no postoperative death has been observed. Conclusion: Our results indicated that bariatric surgery is safe and effective for Japanese. Although the higher disease rate of gastric cancer than western patients, we expect that more clinical trials will be designed and performed for more effective and suitable surgical procedures for Japanese obesity patients. Similar resolution of weight and biochemical aberrations in the first 24 months despite different bariatric procedures Nutrition Course, N.S.Fatima Faculty and University of Sao Paulo, Brazil Nutrition Course, N.S.Fatima Faculty, Caxias do Sul, RS, Brazil Joel Faintuch,Daniela Giesch,Camile Boscaini,Lovaine Rodrigues,Fernanda Pezzi,Rafael M Soares,Francisco J Karkow Introduction: Malabsorptive operations (Scopinaro/SCOP and duodenal switch/DS) are considered more effective than Roux-en-Y gastric bypass (RYGB) for weight reduction and biochemical normalization, but comparative studies are not common . Objective: In a single-center prospective study, outcome in the first two years was comparatively monitored. Methods: Patients (N=41) were submitted to three interventions (SCOP, DS and RYGB) according to clinical criteria. There were no differences regarding age ( 44 ± 11 years), gender ( 83% females) or preoperative BMI or body weight (BMI 46 ± 5 kg/m2). Measurements included hematologic counts, iron, ferritin, triglycerides, total cholesterol and fractions, and glucose., which were documented preoperatively and 1, 3, 6, 12 and 24 months after surgery.Results: Patients submitted to the Scopinaro modality exhibited higher preoperative BMI (not statistically significant), but difference leveled off after 12 months. By the same token most biochemical variables normalized between 6 and 12 months, so that after two years the three populations displayed similar numbers for all documented variables. Conclusions: All three techniques were followed by adequate clinical and biochemical response. Scopinaro candidates were somewhat heavier but reached comparable BMI at the end of the study. Differences between the operations were not obvious during 24 months, and should probably require longer follow-up and superobese participants to be detected. Intragastric balloon treatment for morbid obesity in Japanese patients. 1: Department of Gastrointestinal Surgery, Graduated School of Medicine, The University of Tokyo 2: Department of Gastrointestinal Surgery, Toranomon Hospital Fumihiko Hatao, Masako Ogawa, Yumie Wada, Nobuyuki Shimizu, Yasuyuki Seto Background; Recently, also in Japan, bariatric surgery is a growing trend. We concern that Japanese patients undergoing bariatric surgery are at risk of developing gastric cancer, which is the most common malignancy in Japanese. Therefore, we expect that the temporary placement of intragastric balloon is suitable for Japanese. Methods; We started the clinical trial of intragastric balloon treatment from 2007. We picked up patients according to the inclusion criteria of our institution which was “morbid obesity (BMI ≧ 35) after conservative treatments including admission of more than one week duration and outpatient visit for 6 months.” The balloon was removed within 6 months according to the manufacturer's suggestions. Results; Six patients who met this criteria underwent the placement of intragastric balloon. No complications occurred. The average duration of procedure was 20.8 min. The average length of the hospital stay was 6.0 days. No one needed to remove ahead of schedule. The average weight loss and percent excess weight loss at the time the balloon was removed were 10.4 kg and 19.8%, respectively. Four patients had kept more than 20% of percent excess weight loss 6 months after the balloon removal. However, 2 patients already regained their weight during the placement of intragastric balloon. Conclusion; Intragastric balloon treatment for morbid obesity in Japanese patients is safety and have some efficacy. Intragastric balloon treatment for morbid obesity in Japanese patients. Fumihiko Hatao, Masako Ogawa, Yumie Wada, Nobuyuki Shimizu, Yasuyuki Seto 1: Department of Gastrointestinal Surgery, Graduated School of Medicine, The University of Tokyo 2: Department of Gastrointestinal Surgery, Toranomon Hospital Background; Recently, also in Japan, bariatric surgery is a growing trend. We concern that Japanese patients undergoing bariatric surgery are at risk of developing gastric cancer, which is the most common malignancy in Japanese. Therefore, we expect that the temporary placement of intragastric balloon is suitable for Japanese. Methods; We started the clinical trial of intragastric balloon treatment from 2007. We picked up patients according to the inclusion criteria of our institution which was “morbid obesity (BMI ≧ 35) after conservative treatments including admission of more than one week duration and outpatient visit for 6 months.” The balloon was removed within 6 months according to the manufacturer's suggestions. Results; Six patients who met this criteria underwent the placement of intragastric balloon. No complications occurred. The average duration of procedure was 20.8 min. The average length of the hospital stay was 6.0 days. No one needed to remove ahead of schedule. The average weight loss and percent excess weight loss at the time the balloon was removed were 10.4 kg and 19.8%, respectively. Four patients had kept more than 20% of percent excess weight loss 6 months after the balloon removal. However, 2 patients already regained their weight during the placement of intragastric balloon. Conclusion; Intragastric balloon treatment for morbid obesity in Japanese patients is safety and have