Skip to main content

Experience in laparoscopic sleeve gastrectomy for morbidly obese Taiwanese: staple-line reinforcement is important for preventing leakage

Surgical Endoscopy volume 24, pages 2253–2259 (2010)Cite this article

Abstract

Background

Laparoscopic sleeve gastrectomy (LSG) is a promising procedure for the surgical treatment of morbid obesity. We report our 2-year experience with LSG and specifically evaluate the importance of staple-line protection to prevent leakage after the laparoscopic procedure.

Methods

One hundred eighteen consecutive patients with BMI > 30 who underwent LSG from January 2006 to February 2009 were included in our study. There were 88 women and 30 men with a mean age of 33.2 ± 9.6 years and a mean BMI of 38.0 ± 6.4 kg/m2. The first 40 patients (group 1) underwent the operation without any reinforcement procedure and the other 78 patients received reinforcement of the staple-line (group 2). Data including demographics, hospital stay, blood loss, operative time, complications, excess weight loss percentage (EWL%), and gastrointestinal quality of life index (GIQLI) were collected prospectively for evaluation.

Results

The overall mean operative time was 118.5 ± 37.0 min, mean blood loss was 56.8 ± 56.7 ml, mean hospital stay was 5 ± 3 days. The mean EWL% at 12 and 24 months was 81.5 and 76.0%, respectively. The overall leakage rate was 3.39% (4/118). All leakage occurred in group 1 patients, with a leakage rate of 10% (4/40). Mean preoperative GIQLI was 98.7, and the postoperative GIQLI were 116.4, 115, 112.4, and 97.6 at 3, 6, 12, and 24 months, respectively.

Conclusions

LSG is an effective obesity treatment to achieve significant weight loss after 24 months. Staple-line reinforcement is strongly recommended for laparoscopic sleeve gastrectomy to decrease complications.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Lagacé M, Marceau P, Marceau S, Hould FS, Potvin M, Bourque RA, Biron S (1993) Biliopancreatic diversion with a new type of gastrectomy. Obes Surg 3:29–35

    Article  Google Scholar 

  2. Ren CJ, Patterson E, Gagner M (2000) Early results of biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients. Obes Surg 10:514–523

    CAS  Article  PubMed  Google Scholar 

  3. Fuks D, Verhaeghe P, Brehant O (2009) Results of laparoscopic sleeve gastrectomy: a prospective study in 135 patients with morbid obesity. Surgery 145(1):106–113

    Article  PubMed  Google Scholar 

  4. Arias E, Martínez PR, Ka Ming Li V, Szomstein S, Rosenthal RJ (2009) Mid-term follow-up after sleeve gastrectomy as a final approach for morbid obesity. Obes Surg 19(5):544–548

    Article  PubMed  Google Scholar 

  5. Langer FB, Reza Hoda MA, Bohdjalian A, Felberbauer FX, Zacherl J, Wenzl E, Schindler K, Luger A, Ludvik B, Prager G (2005) Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg 15:1024–1029

    CAS  Article  PubMed  Google Scholar 

  6. Ariyasu H, Takaya K, Tagami T, Ogawa Y, Hosoda K, Akamizu T, Suda M, Koh T, Natsui K, Toyooka S, Shirakami G, Usui T, Shimatsu A, Doi K, Hosoda H, Kojima M, Kangawa K, Nakao K (2001) Stomach is a major source of circulating ghrelin, and feeding state determines plasma ghrelin-like immunoreactivity levels in humans. J Clin Endocrinol Metab 86:4753–4758

    CAS  Article  PubMed  Google Scholar 

  7. Eypasch E, Williams JI, Wood-Dauphinee S, Ure BM, Schmülling C, Neugebauer E, Troidl H (1995) Gastrointestinal quality of life index: development, validation and application of a new instrument. Br J Surg 82:216–222

    CAS  Article  PubMed  Google Scholar 

  8. Roa PE, Kaidar-Person O, Pinto D, Cho M, Szomstein S, Rosenthal RJ (2006) Laparoscopic sleeve gastrectomy as treatment for morbid obesity: technique and short-term outcome. Obes Surg 16:1323–1326

    Article  PubMed  Google Scholar 

  9. Dietel M, Crosby RD, Gagner M (2008) The First International Consensus Summit for Sleeve Gastrectomy (SG), New York City, October 25–27, 2007. Obes Surg 18:487–496

    Article  Google Scholar 

  10. Himpens J (2005) Gastric sleeve resection. In: Himpens J (ed) Laparoscopic bariatric procedures. Tyco Healthcare Group LP, Hampshire, UK, pp 3–14

    Google Scholar 

  11. Han SM, Kim WW, Oh JH (2005) Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obes Surg 15:1469–1475

    Article  Google Scholar 

  12. Frezza EE, Reddy S, Gee LL, Wachtel MS (2008) Complication after sleeve gastrectomy for morbid obesity. Obes Surg 19(6):684–687

    Article  PubMed  Google Scholar 

  13. Lee CM, Cirangle PT, Jossart GH (2008) Laparoscopic vertical sleeve gastrectomy for morbid obesity: a report of a five-year experience with 750 patients. Presented at the 49th annual meeting of the Society for Surgery of the Alimentary Tract, San Diego, CA, May 17–21, 2008

  14. Chen B, Kiriakopoulos A, Tsakayannis D, Wachtel MS, Linos D, Frezza EE (2009) Reinforcement does not necessarily reduce the rate of staple line leaks after sleeve gastrectomy. A review of the literature and clinical experiences. Obes Surg 19:166–172

    Article  PubMed  Google Scholar 

  15. Stroh C, Birk D, Flade-Kuthe R, Frenken M, Herbig B, Höhne S, Köhler H, Lange V, Ludwig K, Matkowitz R, Meyer G, Meyer F, Pick P, Horbach T, Krause S, Schäfer L, Schlensak M, Shang E, Sonnenberg T, Susewind M, Voigt H, Weiner R, Wolff S, Lippert H, Wolf AM, Schmidt U, Manger T, Bariatric Surgery Working Group (2009) A nationwide survey on bariatric surgery in Germany—results 2005–2007. Obes Surg 19:105–112

    Article  PubMed  Google Scholar 

  16. Lee WJ, Wang W, Lee YC, Huang MT, Ser KH, Chen JC (2008) Laparoscopic mini-gastric bypass: experience with tailored bypass limb according to body weight. Obes Surg 18:294–299

    Article  PubMed  Google Scholar 

  17. Wang W, Wei PL, Lee YC, Huang MT, Chiu CC, Lee WJ (2005) Short-term results of laparoscopic mini-gastric bypass. Obes Surg 15:648–654

    Article  PubMed  Google Scholar 

  18. Baker RS, Foote J, Kemmeter P, Brady R, Vroegop T, Serveld M (2004) The science of stapling and leaks. Obes Surg 14:1290–1298

    Article  PubMed  Google Scholar 

  19. Consten EC, Gagner M (2004) Staple-line reinforcement techniques with different buttressing materials used for laparoscopic gastrointestinal surgery: a new strategy to diminish perioperative complications. Surg Technol Int 13:59–63

    PubMed  Google Scholar 

  20. Kasalicky M, Michalsky D, Housova J (2008) Laparoscopic sleeve gastrectomy without over-sewing of the staple line. Obes Surg 18:1257–1262

    Article  PubMed  Google Scholar 

  21. Shikora SA (2004) The use of staple-line reinforcement during laparoscopic gastric bypass. Obes Surg 14:1313–1320

    Article  PubMed  Google Scholar 

  22. Lee MG, Provost DA, Jones DB (2004) Use of fibrin sealant in laparoscopic gastric bypass for morbid obesity. Obes Surg 14:1321–1326

    Article  PubMed  Google Scholar 

  23. Consten EC, Gagner M, Pomp A (2004) Decreased bleeding after laparoscopic sleeve gastrectomy with or without duodenal switch for morbid obesity using a stapled buttressed absorbable polymer membrane. Obes Surg 14:1360–1366

    Article  PubMed  Google Scholar 

  24. Rubin M, Yehoshua RT, Stein M (2008) Laparoscopic sleeve gastrectomy with minimal morbidity Early results in 120 morbidly obese patients. Obes Surg 18(12):1567–1570

    Article  PubMed  Google Scholar 

Download references

Disclosures

Kong-Han Ser, Wei-Jei Lee, Yi-Chih Lee, Jung-Chien Chen, Yen-Hao Su, and Shu-Chun Chen have no conflicts of interest or financial ties to disclose.

Author information

Affiliations

  1. Department of Surgery, Min-Sheng General Hospital, No. 168 Jingguo Rd, Taoyuan City, Taoyuan County, 330, Taiwan, ROC

    Kong-Han Ser, Wei-Jei Lee, Jung-Chien Chen & Yen-Hao Su

  2. Department of International Business, Ching Yun University, Jung-Li City, Taiwan

    Yi-Chih Lee

  3. Department of Nursing, Min-Sheng General Hospital, Taoyuan City, Taiwan

    Shu-Chun Chen

Authors
  1. Kong-Han Ser
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wei-Jei Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yi-Chih Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jung-Chien Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yen-Hao Su
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shu-Chun Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wei-Jei Lee.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ser, KH., Lee, WJ., Lee, YC. et al. Experience in laparoscopic sleeve gastrectomy for morbidly obese Taiwanese: staple-line reinforcement is important for preventing leakage. Surg Endosc 24, 2253–2259 (2010). https://doi.org/10.1007/s00464-010-0945-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-010-0945-x

Keywords

  • Laparoscopic sleeve gastrectomy
  • Staple-line leakage
  • Bariatric surgery
  • Obesity surgery