The appearance of a lurking ligament in Laparoscopic Sleeve Gastrectomy; Posterior Gastric Ligament

Yıl 2017, Cilt: 44 Sayı: 1, 65 - 70, 17.03.2017

Mutlu Ünver , Şafak Öztürk Türker Karabuğa İsmail Özsan Zafer Önen Ünal Aydın

https://doi.org/10.5798/dicletip.298607

Öz

Objective: The aim of this study was to demonstrate a lurking ligament and its various formation types and to mention the importance of this ligament in Laparoscopic sleeve gastrectomy
Methods: One hundred and twelve patients had laparoscopic sleeve gastrectomy (LSG) procedure in our clinic between March 2011 and September 2013. All procedures were performed with a standard operative technique. Only difference for the last 50 patients was to avoid the excessive dissection of posterior gastric wall. The existence of posterior gastric ligament was recorded and different types of posterior gastric ligament was demonstrated.
Results: Posterior gastric ligament was observed in all of the cases in different formation types. Three types of ligament; complete, partial and skippy, was demonstrated. 53(47.3%) of the patients had skippy, while 41 (36.6%) had partial and 18 (16.1%) had complete type of posterior gastric ligament.
Conclusion: A ligament named as ‘posterior gastric ligament’ and its various forms were defined in the third dimensional plane of stomach. Posterior gastric ligament remains as the only structure in LSG for preventing the mobility and ability of the stomach to rotate. The excessive dissection of the posterior gastric ligament should be avoided to prevent complications such as kinking and volvulus

Anahtar Kelimeler

Gastric ligament, sleeve gastrectomy

Kaynakça

• 1. Regan JP, Inabnet WB, Gagner M, et al. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg. 2003; 13:861–4.
• 2. Del Castillo Dejardin D, Pereferrer FS, Gonzales MH, et al. Gastric volvulus after sleeve gastrectomy for morbid obesity. Surgery. 2013; 153;431-3.
• 3. Erenbourg L, Reggiani P. A new ligament: the ‘gastropancreatic’. Anat Clin. 1985; 7:143-4.
• 4. Bortul M, Scaramucci M, Tonello C, et al. Gastric wall necrosis from organo-axial volvulus as a late complication of laparoscopic gastric banding. Obes Surg. 2004; 14:285-7.
• 5. Kicska G, Levine MS, Raper SE, et al. Gastric volvulus after laparoscopic adjustable gastric banding for morbid obesity. Am J Roentgenol. 2007; 189:1469-72.
• 6. Arbell D, Koplewitz B, Zamir G, et al. Midgut volvulus following laparoscopic banding: A rare and dangerous situation. J Laparoendosc Adv Surg Tech. 2007;17:321-3.