Mutlu ÜNVER, CENNET ŞAFAK ÖZTÜRK, Türker KARABUĞA, İsmail ÖZSAN, Zafer ÖNEN, Ünal AYDIN

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

Giriş: Bu çalışmanın amacı, az bilinen bir bağ olan posterior gastrik ligamanın çeşitli tiplerini demonstre etmek ve laparoskopik sleeve gastrektomideki önemine değinmektir. Yöntemler: Kliniğimizde laparoskopik sleeve gastrektomi uygulanan 120 hasta çalışmaya dahil edildi. Son 50 hasta hariç tüm hastalara aynı standart prosedür uygulandı. Son 50 hastada ise posterior gastrik duvarın ileri derecede diseksiyonundan kaçınıldı. Çeşitli posterior gastrik ligaman tipleri demonstre edilerek not edildi. Bulgular: Posterior gastrik ligaman, değişik formasyonlarda da olsa tüm hastalarda gözlendi. Tam, parsiyel ve atlamalı biçimde olan 3 tür posterior gastrik ligaman gözlendi. 53 hastada atlamalı tarzda, 41 hastada parsiyel ve 18 hastada tam posterior gastrik ligaman gözlendi. Tartışma ve Sonuç: Posterior gastrik ligaman adı verilen ve çeşitli formasyonlarda olan bu bağ 3 boyutlu olarak tanımlanmıştır. Laparoskopik sleeve gastrektomi sonrası, midenin rotasyonunu ve hareket kabiliyetini sınırlayan tek yapı posterior gastrik ligamandır. Kink ve volvulus gibi lomplikasyonlardan kaçınmak için ileri derecede olan posterior gastrik ligaman diseksiyonundan kaçınılmalıdır

Laparoskopik Sleeve Gastrektomide ortaya çıkan gizlenmiş bir ligaman: Posterior gastrik ligaman

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

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