Skip to main content

Advertisement

SpringerLink
Log in

Laparoscopic Sleeve Gastrectomy With or Without Staple Line Inversion and Distal Fixation to the Transverse Mesocolon: Impact on Early Postoperative Outcomes

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background and Aim

Staple line complications and axial rotation of the gastric tube after sleeve gastrectomy are well-recognized complications of the procedure. The present study aims to investigate the role of staple line inversion and distal fixation to the transverse mesocolon in reducing these complications.

Patients and Methods

This is a retrospective analysis of prospectively collected data of 252 patients with morbid obesity who underwent laparoscopic sleeve gastrectomy (LSG). Patients were subdivided into two groups: group I comprising 124 patients did not have distal sleeve fixation and group II comprising 128 patients underwent staple line inversion and distal fixation.

Results

Patients were 171 females and 81 males with a mean age of 33.2 ± 8.7 years and a mean preoperative body mass index (BMI) of 50.9 ± 8.6 Kg/m2. The mean operating time was 103.9 ± 26.9 min and the median hospital stay was 1 day. Major complications were detected in 15 (5.9 %) patients, who were all in group I. Group I had significantly shorter operative time and significantly higher rates of staple line bleeding (4 % in group I versus 0 in group II) and gastric axial rotation (5.6 % in group I versus 0 in group II). There were no significant differences between the two groups regarding early postoperative vomiting (21.7 % versus 26.5 %) and staple line leak (2.4 % versus 0).

Conclusion

Staple line inversion and distal fixation to the transverse mesocolon can be a simple, effective strategy to prevent staple line bleeding, and gastric axial rotation, though it prolonged the operative time of LSG.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Trelles N, Michel G. Updated review of sleeve gastrectomy. Open Gastroenterol J. 2008;2:41–9.

    Article  Google Scholar 

  2. Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc. 2006;20(6):859–63.

    Article  CAS  PubMed  Google Scholar 

  3. Godoy E, Coelho D. Gastric sleeve fixation strategy in laparoscopic vertical sleeve gastrectomy. ABCD Arq Bras Cir Dig. 2013;26(Suplemento 1):79–82.

    Article  PubMed  Google Scholar 

  4. Langer FB, Reza Hoda MA, Bohdjalian A, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg. 2005;15(7):1024–9.

    Article  CAS  PubMed  Google Scholar 

  5. Shi X, Karmali S, Sharma A, Birch D. A review of laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg. 2010;20:1171–7.

    Article  PubMed  Google Scholar 

  6. Lalor PF, Tucker ON, Szomstein S, Rosenthal RJ. Complications after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2008;4(1):33–8.

    Article  PubMed  Google Scholar 

  7. Wang Z, Dai X, Xie H, Feng J, Li Z, Lu Q. The efficacy of staple line reinforcement during laparoscopic sleeve gastrectomy: a meta-analysis of randomized controlled trials. Int J Surg 2015 Dec 15;25:145–152. doi: 10.1016/j.ijsu.2015.12.007

  8. Chakravartty S, Sarma DR, Chang A, Patel AG 2015 Staple line bleeding in sleeve gastrectomy—a simple and cost-effective solution. Obes Surg. Dec 22.

  9. Fried M, Hainer V, Basdevant A, et al. Inter-disciplinary European guidelines on surgery of severe obesity. Int J Obes. 2007;31:569–77.

    CAS  Google Scholar 

  10. National Institute of Health, National Heart, Lung and Blood Institute (NHLBA) in cooperation with The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDKD) 1998 Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Bethesda, MD: NIH.

  11. Sarkhosh K, Birch DW, Sharma A, Karmali S. Complications associated with laparoscopic sleeve gastrectomy for morbid obesity: a surgeon’s guide. Can J Surg. 2013;56(5):347–52. doi:10.1503/cjs.033511.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Moon Han S, Kim WW, Oh JH. Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obes Surg. 2005;15:1469–75.

    Article  PubMed  Google Scholar 

  13. Abou Rached A, Basile M, El Masri H. Gastric leaks post sleeve gastrectomy: review of its prevention and management. World J Gastroenterol : WJG. 2014;20(38):13904–10. doi:10.3748/wjg.v20.i38.13904.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Rosenthal RJ; International Sleeve Gastrectomy Expert Panel, Diaz AA, Arvidsson D, Baker RS, Basso N, Bellanger D, et al. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis 2012 Jan-Feb. 8(1):8–19.

  15. Kolakowski S, Kirkland ML, Scuricht AL. Routine postoperative upper gastrointestinal series after Roux-en-Y gastric bypass. Arch Surg. 2007;142:930–4.

    Article  PubMed  Google Scholar 

  16. Dapri G, Cadiere GB, Himpens J. Reinforcing the staple line during laparoscopic sleeve gastrectomy: prospective randomized clinical study comparing three different techniques. Obes Surg. 2010;20:462–7.

    Article  PubMed  Google Scholar 

  17. Albanopoulos K, Alevizos L, Flessas J, et al. Reinforcing the staple line during laparoscopic sleeve gastrectomy: prospective randomized clinical study comparing two different techniques. Preliminary results. Obes Surg. 2012;22:42–6.

    Article  PubMed  Google Scholar 

  18. Wang Z, Dai X, Xie H, Feng J, Li Z, Lu Q. The efficacy of staple line reinforcement during laparoscopic sleeve gastrectomy: a meta-analysis of randomized controlled trials. Int J Surg 2016 Jan;25:145–152. doi: 10.1016/j.ijsu.2015.12.007.

  19. Nienhuijs SW, Kaymak U, Korsten E, Buise MP. Influence of intraoperative hypotension on leaks after sleeve gastrectomy. Surg Obes Relat Dis 2015 Oct 29 7289 (15)00813–00818. doi: 10.1016/j.soard.2015.08.506.

  20. Afaneh C, Costa R, Pomp A, Dakin G. A prospective randomized controlled trial assessing the efficacy of omentopexy during laparoscopic sleeve gastrectomy in reducing postoperative gastrointestinal symptoms. Surg Endosc 2015 Jan;29 (1):41–47. doi: 10.1007/s00464-014-3651-2.

  21. Smith RJ. Volvulus of the stomach. J Natl Med Assoc. 1983;75(4):393–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  22. Askew AR. Treatment of acute and chronic gastric volvulus. Ann R Coll Surg Engl. 1978;60(4):326–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Wastell C, Ellis H. Volvulus of the stomach: a review with a report of 8 cases. Br J Surg. 1971;58(8):557–62.

    Article  CAS  PubMed  Google Scholar 

  24. Del Castillo Déjardin D, Sabench Pereferrer F, Hernàndez Gonzàlez M, Blanco Blasco S, Cabrera Vilanova A. Gastric volvulus after sleeve gastrectomy for morbid obesity. Surgery 2013 Mar;153(3):431–433. doi: 10.1016/j.surg.2011.12.023.

  25. Murcia CH, Quintero PG, Rabaza J, Gonzalez A. Laparoscopic management of gastric torsion after sleeve gastrectomy. CRSLS:e2014–00143. doi:10.4293/CRSLS.2014.00143.

  26. Santoro S. Technical aspects in sleeve gastrectomy. Obes Surg. 2007;17(11):1534–5.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. General surgery department, Faculty of Medicine, Mansoura University Hospitals, Elgomhuoria Street, Mansoura city, Egypt

    Emad Abdallah, Sameh Hany Emile & Hossam Elfeki

Authors
  1. Emad Abdallah
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sameh Hany Emile
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hossam Elfeki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sameh Hany Emile.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in the study 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 (retrospective study), formal consent was not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abdallah, E., Emile, S.H. & Elfeki, H. Laparoscopic Sleeve Gastrectomy With or Without Staple Line Inversion and Distal Fixation to the Transverse Mesocolon: Impact on Early Postoperative Outcomes. OBES SURG 27, 323–329 (2017). https://doi.org/10.1007/s11695-016-2277-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-016-2277-y

Keywords

Search

Navigation