Management of Large Subcardial Diverticula in Sleeve Gastrectomy: Technical Tips

Author:

Frattini Francesco1,Pino Antonella1,Cordaro Giuseppe1,Lianos Georgios2ORCID,Bertoli Simona3ORCID,Dionigi Gianlorenzo1

Affiliation:

1. Division of Surgery, IRCCS Istituto Auxologico Italiano, 20122 Milan, Italy

2. Department of Surgery, University of Ioannina, 45332 Ioannina, Greece

3. Obesity Unit, IRCCS Istituto Auxologico Italiano, University of Milan, 20122 Milan, Italy

Abstract

Gastric diverticula are uncommon anatomic abnormalities that are usually asymptomatic or found incidentally in upper gastrointestinal radiographs with contrast or endoscopy. Gastric diverticula usually arise from the wall of the gastric fundus. Their preoperative study or intraoperative finding is of great importance in patients with obesity who are scheduled for bariatric surgery. In bariatric surgery, and especially in sleeve gastrectomy, it is of utmost importance to know the exact location of the diverticulum in order to position the stapler correctly and to perform appropriate gastric resection including the diverticulum. Sleeve gastrectomy has gained popularity worldwide and currently accounts for the most performed bariatric procedure according to more recent international surveys. It is considered to be a technically easy procedure. Nonetheless, some steps of the procedure, such as gastric fundus mobilization and the gastric resection with the use of the stapler, may be challenging in patients with a high BMI and in the presence of abnormalities of the gastric wall. This can represent a risk for the occurrence of complications such as a gastric leak or bleeding. We propose some considerations about technical tips to adopt for safely performing sleeve gastrectomy in the presence of a subcardial diverticulum.

Publisher

MDPI AG

Subject

General Earth and Planetary Sciences,General Environmental Science

Reference13 articles.

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