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Laparoscopic Reinforced Sleeve Gastrectomy: Early Results and Complications

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Abstract

Background

Sleeve gastrectomy (SG) was pioneered as a two-stage intervention for super and super-super obesity to minimize morbidity and mortality; it is employed increasingly as a primary procedure. Early outcomes and integrity of laparoscopic SG (LSG) against leak using a technique incorporating gastric transection-line reinforcement were studied.

Methods

Between 2003 and 2009, 121 patients underwent LSG (16, two-stage; 105, primary). Of the patients, 66% were women, mean age 38.8 ± 10.9 (15.0–64.0), and body mass index (BMI, kg/m2) 48.7 ± 9.3 (33.7–74.8). Bovine pericardium (Peri-Strips Dry [PSD]) was used to reinforce the staple line. Parametric and nonparametric tests were used, as appropriate. The paired t test was used to assess change from baseline; bivariate analyses and logistic regression were used to identify preoperative patient characteristics predictive of suboptimal weight loss.

Results

Mean operative time was 105 min (95–180), and mean hospitalization was 5.6 days (1–14). There was no mortality. There were 6 (5.0%) complications: 1 intraoperative leak, 1 stricture, 1 trocar-site bleed, 1 renal failure, and 2 wound infections. There were no postoperative staple-line leaks. Following 15 concomitant hiatal hernia operations, 3 (20%) recurred: 1 revised to RYGB and 2 in standby. Two post-LSG hiatal hernias of the two-stage series required revisions because of symptoms. BMI decreased 24.7% at 6 months (n = 55) to 37.5 ± 9.3 (22.2–58.1); %EWL was 48.1 ± 19.3 (15.5–98.9). Twelve-month BMI (n = 41) was 38.4 ± 10.5 (19.3–62.3); %EWL was 51.7 ± 25.0 (8.9–123.3). Forty-eight-month BMI (n = 13) was 35.6 ± 6.8 (24.9–47.5); %EWL was 61.1 ± 12.2 (43.9–82.1) (p < 0.001). Preoperative BMI was predictive of >70% of patients who experienced <50% EWL at 6 months. At 2 weeks, 100% of type 2 diabetes patients (n = 23) were off medication (mean HbA1C, 5.9 ± 0.5%; glycemia, 90.0 ± 19.9 mg/dL (p < 0.01) at 3 months).

Conclusions

Laparoscopic PSD-reinforced LSG as a staged or definitive procedure is safe and effective in the short term and provides rapid type 2 diabetes mellitus reduction with a very low rate of complications.

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Acknowledgments

We thank Giuliana Vitolo and Maria Police of the Department of Surgery, San Giovanni Bosco Hospital, Naples, Italy, for their invaluable help in collecting the data, and for their support in the management and follow-up of patients. This work was supported by Synovis Life Technologies, Inc.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. General and Laparoscopic Surgery Unit, San Giovanni Bosco Hospital, Naples, Italy

    Luigi Angrisani, Pier Paolo Cutolo & Francesco Persico

  2. Division of Scientific Writing, Medwrite Medical Communications, Maiden Rock, WI, USA

    Jane N. Buchwald

  3. Statistical Analysis and Quality of Life Assessment, McGlennon MotiMetrics, Maiden Rock, WI, USA

    Tim W. McGlennon

  4. Department of Molecular and Clinical Endocrinology and Oncology, Federico II Medical School, University of Naples, Naples, Italy

    Gabriella Nosso, Brunella Capaldo & Silvia Savastano

  5. General and Laparoscopic Surgery Unit, San Giovanni Bosco Hospital, University Federico II, Medical School, via F.M. Briganti 255, 80144, Naples, Italy

    Luigi Angrisani

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  1. Luigi Angrisani
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  2. Pier Paolo Cutolo
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Correspondence to Luigi Angrisani.

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Angrisani, L., Cutolo, P.P., Buchwald, J.N. et al. Laparoscopic Reinforced Sleeve Gastrectomy: Early Results and Complications. OBES SURG 21, 783–793 (2011). https://doi.org/10.1007/s11695-011-0400-7

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