EVOLUTION OF LAPAROSCOPIC TECHNIQUES IN BARIATRIC SURGERY Giovanni DAPRI © Copyright Giovanni DAPRI, Maastricht 2013. All rights reserved. No part of this thesis may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage or retrieval system without permission from the author, or when appropriate, from the publishers of the publications. Production: Datawyse | Universitaire Pers Maastricht ISBN 978 94 6159 228 6 EVOLUTION OF LAPAROSCOPIC TECHNIQUES IN BARIATRIC SURGERY DISSERTATION to obtain the degree of Doctor at Maastricht University, on the authority of the Rector Magnificus, Prof. dr. L.L.G. Soete in accordance with the decision of the Board of Deans, to be defended in public on Friday 17 May 2013, at 10.00 hours by Giovanni Dapri UMP UNIVERSITAIRE PERS MAASTRICHT Promotor Prof. dr. J.W.M. Greve Co-Promotors Prof. dr. G-B. Cadière Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium Prof. dr. J. Himpens AZ Sint-Blasius, Dendermonde, Belgium Assessment Committee Prof. dr. J.G. Maessen (Chair) Prof. dr. L.P.S. Stassen Prof. dr. P.B. Soeters Prof. dr. R. Weiner University of Frankfurt, Germany Dr. R. Schouten Bariatrisch Centrum Lievensberg Ziekenhuis, Bergen op Zoom CONTENTS Chapter 1 ................................................................................................................................ 9 GENERAL INTRODUCTION 1.1 Obesity ....................................................................................................................................11 1.2 Bariatric Surgery ................................................................................................................12 1.3 Development of Laparoscopic Procedures .............................................................12 1.4 Failures/Complications and Need for Revisions..................................................13 1.5 Search for Possible Strategies to Treat Failures...................................................14 1.6 New Development .............................................................................................................15 1.7 References .............................................................................................................................16 Chapter 1b............................................................................................................................23 INTRODUCTION TO THE STUDIES AND AIM OF THE THESIS Chapter 2 ..............................................................................................................................27 RANDOMIZED STUDY COMPARING TWO DIFFERENT TECHNIQUES FOR LAPAROSCOPIC SLEEVE GASTRECTOMY 2.1 Abstract...................................................................................................................................29 2.2 Introduction..........................................................................................................................30 2.3 Patients and Methods.......................................................................................................30 2.3.1 Surgical Technique.............................................................................................................31 2.4 Results.....................................................................................................................................35 2.5 Discussion..............................................................................................................................36 2.6 References .............................................................................................................................38 Chapter 3 ..............................................................................................................................41 RANDOMIZED STUDY IN LAPAROSCOPIC SLEEVE GASTRECTOMY COMPARING THE REINFORCEMENT OF THE STAPLE LINE 3.1 Abstract...................................................................................................................................43 3.2 Introduction..........................................................................................................................44 3.3 Patients and Methods.......................................................................................................44 3.3.1 Surgical Technique …………………………………………………………………………….46 3.4 Results.....................................................................................................................................47 3.5 Discussion..............................................................................................................................49 3.6 Conclusion .............................................................................................................................51 3.7 References .............................................................................................................................52 Chapter 4 ..............................................................................................................................55 LAPAROSCOPIC CONVERSION OF ADJUSTABLE GASTRIC BAND TO SLEEVE GASTRECTOMY 4.1 Abstract...................................................................................................................................57 4.2 Introduction..........................................................................................................................58 4.3 Patients and Methods.......................................................................................................58 4.3.1 Surgical Technique.............................................................................................................59 4.4 Results.....................................................................................................................................60 4.5 Discussion..............................................................................................................................60 4.6 Conclusion .............................................................................................................................62 4.7 References .............................................................................................................................62 Chapter 5 ..............................................................................................................................65 LAPAROSCOPIC REVISION OF SLEEVE GASTRECTOMY: RE-SLEEVE VERSUS DUODENAL SWITCH 5.1 Abstract...................................................................................................................................67 5.2 Introduction..........................................................................................................................68 5.3 Patients and Methods.......................................................................................................68 5.3.1 Surgical Technique.............................................................................................................69 5.4 Results.....................................................................................................................................70 5.5 Discussion..............................................................................................................................72 5.6 Conclusion .............................................................................................................................75 5.7 References .............................................................................................................................75 Chapter 6 ..............................................................................................................................77 LAPAROSCOPIC CONVERSION OF ADJUSTABLE GASTRIC BAND AND VERTICAL BANDED GASTROPLASTY TO DUODENAL SWITCH 6.1 Abstract...................................................................................................................................79 6.2 Introduction..........................................................................................................................80 6.3 Patients and Methods.......................................................................................................80 6.3.1 Surgical Technique.............................................................................................................81 6.4 Results.....................................................................................................................................82 6.5 Discussion..............................................................................................................................85 6.6 Conclusion .............................................................................................................................86 6.7 References .............................................................................................................................87 Chapter 7 ..............................................................................................................................91 TWO-STEP LAPAROSCOPIC DUODENAL SWITCH 7.1 Abstract...................................................................................................................................93 7.2 Introduction..........................................................................................................................94 7.3 Patients and Methods.......................................................................................................94