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The Impact of Technical Surgical Aspects on Morbidity of 984 Patients after Sleeve Gastrectomy for Morbid Obesity.

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Abstract

Background

To evaluate early complications after LSG in regard of staple line reinforcement (SLR), bougie size, previous bariatric surgery and surgeon experience.

Methods

A retrospective cohort study of LSG patients at the Soroka University Medical Center (SUMC). Data was collected from digitalized database.

Results

Nine hundred eighty-four LSG cases were performed by three surgeons. Seventy-eight complications were observed (7.9%): 44 mild (4.5%) and 34 severe (3.4%). Over-sewing of staple line was performed in 689 cases (76.2%), and no SLR in 217 cases (24.0%) without significant impact on mild or severe early morbidity. Bougie size 36 Fr or smaller was used in 635 cases (73.0%) without significant differences in early complications compared to 235 cases (27.0%) with larger bougie. LSG, as revision bariatric surgery, was performed in 273 cases (27.7%). Concomitant removal of a gastric band was performed in 199 of these cases (72.9%). History of silastic ring vertical gastroplasty (SRVG) was recorded in 10 cases (1.0%). Previous bariatric surgery was a significant risk factor for early mild complications (OR = 1.14, p value = 0.02), but not for severe ones (OR = 0.79, p value = 0.09). Concomitant removal of gastric band did not affect this result. The risk for mild complication was significantly reduced with surgeon experience achieving 100 cases.

Conclusions

SLR or bougie size is not affecting LSG morbidity, but previous bariatric history and surgeon experience are significant factors for early mild complications.

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References

  1. Wölnerhanssen B, Peterli R. State of the art: sleeve gastrectomy. Dig Surg. 2014;31(1):40–7.

    Article  PubMed  Google Scholar 

  2. Gagner M, Buchwald JN. Comparison of laparoscopic sleeve gastrectomy leak rates in four staple-line reinforcement options: a systematic review. Surg Obes Relat Dis. 2014;10:713–23.

    Article  PubMed  Google Scholar 

  3. Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA, et al. International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of>12,000 cases. Surg Obes Relat Dis. 2012;8:8–19.

    Article  PubMed  Google Scholar 

  4. Sakran N, Goitein D, Raziel A, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc. 2013;27:240–5.

    Article  PubMed  Google Scholar 

  5. Gill RS, Switzer N, Driedger M, et al. Laparoscopic sleeve gastrectomy with staple line buttress reinforcement in 116 consecutive morbidly obese patients. Obes Surg. 2012;22:560–4.

    Article  PubMed  Google Scholar 

  6. Musella M, Milone M, Maietta P, et al. Laparoscopic sleeve gastrectomy: efficacy of fibrin sealant in reducing postoperative bleeding. A randomized controlled trial. Updat Surg. 2014;66:197–201.

    Article  Google Scholar 

  7. Owens M, Sczepaniak J, Mahdavi A. “Inverted corner” for sleeve gastrectomy. Surg Obes Relat Dis. 2012;8:364–5.

    Article  PubMed  Google Scholar 

  8. Yuval JB, Mintz Y, Cohen MJ, et al. The effects of bougie caliber on leaks and excess weight loss following laparoscopic sleeve gastrectomy. Is there an ideal bougie size. Obes Surg. 2013;23:1685–91.

    Article  PubMed  Google Scholar 

  9. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96. Appendix A

    Article  PubMed  Google Scholar 

  10. Berger ER, Clements RH, Morton JM, et al. The impact of different surgical techniques on outcomes in laparoscopic sleeve Gastrectomies: the First Report from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). Ann Surg. 2016;264(3):464–73.

    Article  PubMed  Google Scholar 

  11. D'Ugo S, Gentileschi P, Benavoli D, et al. Comparative use of different techniques for leak and bleeding prevention during laparoscopic sleeve gastrectomy: a multicenter study. Surg Obes Relat Dis. 2014;10(3):450–4.

    Article  PubMed  Google Scholar 

  12. Shikora SA, Mahoney CB. Clinical benefit of gastric staple line reinforcement (SLR) in gastrointestinal surgery: a meta-analysis. Obes Surg. 2015;25(7):1133–41.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Carandina S, Tabbara M, Bossi M, et al. Staple line reinforcement during laparoscopic sleeve gastrectomy: absorbable monofilament, barbed suture, fibrin glue, or nothing? Results of a prospective randomized study. J Gastrointest Surg. 2016;20(2):361–6.

    Article  CAS  PubMed  Google Scholar 

  14. Gagner M, Hutchinson C, Rosenthal R. Fifth International Consensus Conference: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2016;12(4):750–6.

    Article  PubMed  Google Scholar 

  15. Sánchez-Santos R, Corcelles Codina R, Vilallonga Puy R et al. Prognostic factors for morbimortality in sleeve gastrectomy. The importance of the learning curve. A Spanish-Portuguese Multicenter Study. Obes Surg. 2016 May 19

  16. Parikh M, Issa R, McCrillis A, et al. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg. 2013;257(2):231–7.

    Article  PubMed  Google Scholar 

  17. Hawasli A, Jacquish B, Almahmeed T, et al. Early effects of bougie size on sleeve gastrectomy outcome. Am J Surg. 2015;209(3):473–7.

    Article  PubMed  Google Scholar 

  18. Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26(6):1509–15.

    Article  PubMed  Google Scholar 

  19. Cal P, Deluca L, Jakob T, et al. Laparoscopic sleeve gastrectomy with 27 versus 39 Fr bougie calibration: a randomized controlled trial. Surg Endosc. 2016;30(5):1812–5.

    Article  PubMed  Google Scholar 

  20. Sabbagh C, Verhaeghe P, Dhahri A, et al. Two-year results on morbidity, weight loss and quality of life of sleeve gastrectomy as first procedure, sleeve gastrectomy after failure of gastric banding and gastric banding. Obes Surg. 2010;20(6):679–84.

    Article  PubMed  Google Scholar 

  21. Bernante P, Foletto M, Busetto L, et al. Feasibility of laparoscopic sleeve gastrectomy as a revision procedure for prior laparoscopic gastric banding. Obes Surg. 2006;16(10):1327–30.

    Article  PubMed  Google Scholar 

  22. Uglioni B, Wölnerhanssen B, Peters T, et al. Midterm results of primary vs. secondary laparoscopic sleeve gastrectomy (LSG) as an isolated operation. Obes Surg. 2009;19(4):401–6.

    Article  PubMed  Google Scholar 

  23. Foletto M, Prevedello L, Bernante P, et al. Sleeve gastrectomy as revisional procedure for failed gastric banding or gastroplasty. Surg Obes Relat Dis. 2010;6(2):146–51.

    Article  PubMed  Google Scholar 

  24. Elazary R, Hazzan D, Appelbaum L, et al. Feasibility of sleeve gastrectomy as a revision operation for failed silastic ring vertical gastroplasty. Obes Surg. 2009;19(5):645–9.

    Article  PubMed  Google Scholar 

  25. Alqahtani AR, Elahmedi M, Alamri H, et al. Laparoscopic removal of poor outcome gastric banding with concomitant sleeve gastrectomy. Obes Surg. 2013;23(6):782–7.

    Article  PubMed  Google Scholar 

  26. Ramly EP, Alami RS, Tamim H, et al. Concomitant removal of gastric band and sleeve gastrectomy: analysis of outcomes and complications from the ACS-NSQIP database. Surg Obes Relat Dis. 2016;12(5):984–8.

    Article  PubMed  Google Scholar 

  27. Goitein D, Feigin A, Segal-Lieberman G, et al. Laparoscopic sleeve gastrectomy as a revisional option after gastric band failure. Surg Endosc. 2011;25(8):2626–30.

    Article  PubMed  Google Scholar 

  28. Bhasker A, Gadgil M, Muda NH, et al. Revisional bariatric surgery for failed gastric banding in Asia: a review of choice of revisional procedure, surgical technique and postoperative complication rates. Asian J Endosc Surg. 2011;4(1):26–31.

    Article  CAS  PubMed  Google Scholar 

  29. Noel P, Nedelcu M, Gagner M. Impact of the surgical experience on leak rate after laparoscopic sleeve gastrectomy. Obes Surg. 2016;26(8):1782–7.

    Article  PubMed  Google Scholar 

  30. Zacharoulis D, Sioka E, Papamargaritis D, et al. Influence of the learning curve on safety and efficiency of laparoscopic sleeve gastrectomy. Obes Surg. 2012;22(3):411–5.

    Article  PubMed  Google Scholar 

  31. Daskalakis M, Berdan Y, Theodoridou S, et al. Impact of surgeon experience and buttress material on postoperative complications after laparoscopic sleeve gastrectomy. Surg Endosc. 2011;25(1):88–97.

    Article  PubMed  Google Scholar 

  32. Varban OA, Sheetz KH, Cassidy RB, et al. Evaluating the effect of operative technique on leaks after laparoscopic sleeve gastrectomy: a case-control study. Surg Obes Relat Dis. 2016 Dec 10.

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Authors and Affiliations

  1. Department General Surgery B, Soroka University Medical Center, POB 151, Beer Sheva, Israel

    Ohad Guetta, Amnon Ovnat, David Czeiger, Alex Vakhrushev & Gilbert Sebbag

  2. Department of Public Health, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel

    Gal Tsaban

Authors
  1. Ohad Guetta
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  2. Amnon Ovnat
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  3. David Czeiger
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  4. Alex Vakhrushev
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Correspondence to Ohad Guetta.

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The authors declare that they have no conflict of interest.

Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

For this type of study, formal consent is not required. No identifying information was used in this study.

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Guetta, O., Ovnat, A., Czeiger, D. et al. The Impact of Technical Surgical Aspects on Morbidity of 984 Patients after Sleeve Gastrectomy for Morbid Obesity.. OBES SURG 27, 2785–2791 (2017). https://doi.org/10.1007/s11695-017-2721-7

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  • DOI: https://doi.org/10.1007/s11695-017-2721-7

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