Blind nasogastric tube advancement following sleeve gastrectomy: an animal model

  • Thomas Fabian
  • Tyler RobinsonEmail author
  • Lauren Naile
  • Michael P. Smith
  • Mara McErlean



Sleeve gastrectomy is an effective surgical treatment for morbid obesity. The major technical risk of this procedure is staple line dehiscence. Some surgeons are reluctant to place a nasogastric tube (NGT) blindly due to the perceived risk of damage to the staple line. We sought to determine whether such concern was warranted.


A porcine tissue model (Animal Technologies, Inc., Tyler, TX) was used. Sleeve gastrectomy was performed using a flexible gastroscope as a guide for the Endo GIA stapler (Covidien, New Haven, CT) in an identical fashion used in our patients. The specimen was then placed in a plastic model of the thorax (VATS Trainers, LLC. Lansing, MI). The NGT was blindly advanced to 55 cm for a total of 50 passes, and to 75 cm for another 50 passes. Endoscopy with water submersion was performed to evaluate for injury or leak.


After multiple passes of the NGT, no significant injuries, leaks, or perforations were observed to the gastric model, except for several small petechiae of the gastric mucosa, the largest measuring approximately 3 mm. None were of full thickness or penetrated the mucosa. The staple line showed no evidence of trauma.


In this porcine model, blind NGT placement was not associated with significant mucosal injury or any damage to the sleeve gastrectomy staple line.


Nasogastric tube Sleeve gastrectomy Staple line Perforation 



We extend our appreciation to Charles Albertson, Daniel Shovlin, and Sandy Waters for their technical support and expertise.

Authors contribution

T.F. and M.M. designed the study; T.F., L.N., T.R. and M.M. performed the literature review; T.F., M.M. and M.S. performed the experiment and analyzed the data; T.F., T.R., L.N. and M.M. wrote the manuscript. All authors approved the final version of the manuscript.


No extramural funding or grants were used for this project. Resources used were already available within the college.

Compliance with ethical standards


Drs. Fabian, Robinson, Naile, Smith, and McErlean have no conflicts of interest and no financial ties to disclose.


  1. 1.
    Depaula AL, Stival AR, Halpern A, Vencio S (2011) Surgical treatment of morbid obesity: mid-term outcomes of the laparoscopic ileal interposition associated to a sleeve gastrectomy in 120 patients. Obes Surg 21(5):668–675. CrossRefGoogle Scholar
  2. 2.
    Tan JT, Kariyawasam S, Wijeratne T, Chandraratna HS (2010) Diagnosis and management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg 20(4):403–409. CrossRefGoogle Scholar
  3. 3.
    Gill RS, Birch DW, Shi X, Sharma AM, Karmali S (2010) Sleeve gastrectomy and type 2 diabetes mellitus: a systematic review. Surg Obes Relat Dis 6(6):707–713. CrossRefGoogle Scholar
  4. 4.
    Sarkhosh K, Birch DW, Shi X, Gill RS, Karmali S (2012) The impact of sleeve gastrectomy on hypertension: a systematic review. Obes Surg 22(5):832–837. CrossRefGoogle Scholar
  5. 5.
    Kokkinos A, Alexiadou K, Liaskos C et al (2013) Improvement in cardiovascular indices after Roux-en-Y gastric bypass or sleeve gastrectomy for morbid obesity. Obes Surg 23(1):31–38. CrossRefGoogle Scholar
  6. 6.
    Campanile FC, Boru CE, Rizzello M et al (2013) Acute complications after laparoscopic bariatric procedures: update for the general surgeon. Langenbecks Arch Surg 398(5):669–686. CrossRefGoogle Scholar
  7. 7.
    Gagner M, Deitel M, Erickson AL, Crosby RD (2013) Survey on laparoscopic sleeve gastrectomy (LSG) at the fourth international consensus summit on sleeve gastrectomy. Obes Surg 23(12):2013–2017. CrossRefGoogle Scholar
  8. 8.
    Aurora AR, Khaitan L, Saber AA (2012) Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc 26(6):1509–1515. CrossRefGoogle Scholar
  9. 9.
    Causey MW, Fitzpatrick E, Carter P (2013) Pressure tolerance of newly constructed staple lines in sleeve gastrectomy and duodenal switch. Am J Surg 205(5):571–575. CrossRefGoogle Scholar
  10. 10.
    López-Monclova J, Soler ET, Ponz CB, Vilallonga R, Rodríguez-Gómez K, Baeza-Vitolas M (2013) Pilot study comparing the leak pressure of the sleeved stomach with and without reinforcement. Surg Endosc 27(12):4721–4730. CrossRefGoogle Scholar
  11. 11.
    Benedix F, Poranzke O, Adolf D et al (2017) Staple line leak after primary sleeve gastrectomy—risk factors and mid-term results: do patients still benefit from the weight loss procedure? Obes Surg 27(7):1780–1788. CrossRefGoogle Scholar
  12. 12.
    Sakran N, Goitein D, Raziel A et al (2013) Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc 27(1):240–245. CrossRefGoogle Scholar
  13. 13.
    Kasalicky M, Dolezel R, Vernerova E, Haluzik M (2014) Laparoscopic sleeve gastrectomy without over-sewing of the staple line is effective and safe. Wideochir Inne Tech Maloinwazyjne 9(1):46–52. Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of SurgeryAlbany Medical CollegeAlbanyUSA
  2. 2.Department of PediatricsPhoenix Children’s HospitalPhoenixUSA
  3. 3.Division of Anatomy, Department of Medical EducationAlbany Medical CollegeAlbanyUSA
  4. 4.Department of Medical Education, Patient Safety and Clinical Competency CenterAlbany Medical CollegeAlbanyUSA

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