Surgical Techniques
hiatal hernia, ®
DISSECTION, ADHESIONS
Five standard ports were used, including three 12-mm ports (for the camera, right and left working ports) and two 5-mm ports (for liver retraction and the assistant). Pneumo-peritoneum was created after using optical trocars for entry while paying attention to the presence of adhesions from previous surgery. Dissection of adhesions around the gastric sleeve was performed using the energy device EnSeal® (Ethicon Endo-Surgery, Cincinnati, OH, USA). During reversion LSG, the stomach was resected 6 cm from the pylorus using a 40 French bougie with five standard ports. BLSG and NBLSG were reinforced and oversewed using absorbable 3/0 v-loc-sutures (Covidien, Mansfield, MA, USA).For the BLSG group, peri gastric dissection was performed 4–5 cm from the gastroesophageal junction, and a size 7.5 (1.75 cm internal diameter) MiniMizer Gastric Ring® (Bariatric Solutions International, Switzerland) was placed loosely around the pouch. Non-absorbable sutures were used to fix the ring to the stomach passing through the built-in holes in the ring. Concomitant operative procedures included crural repair when hiatal hernia was present using unidirectional barbed 2/0 V-Loc non-absorbable sutures (Covidien, Mansfield, MA, USA), and cholecystectomy using the same ports.