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Proximal Leakage After Laparoscopic Sleeve Gastrectomy: an Analysis of Preoperative and Operative Predictors on 1738 Consecutive Procedures

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Abstract

Background

The purpose of this paper was to search for predictive factors for proximal leakage after laparoscopic sleeve gastrectomy (LSG) in a large cohort from a single referral center.

Materials and Methods

One thousand seven hundred and thirty-eight patients, collected in a prospectively held database from 2008 to 2016, were retrospectively analyzed. The correlation between postoperative leakage and both preoperative (age, gender, height, weight, BMI, and obesity-related morbidities) and operative variables (the distance from pylorus at which the gastric section was started, operative time, experience of surgeons who performed the LSG, and the surgical materials used) was analyzed. The experience of the surgeons was calculated in the number of LSGs performed. The surgical materials considered were stapler, cartridges, and reinforcement of the suture.

Results

Proximal leakage was observed in 45 patients out of 1738 (2.6%). No correlation was found between leakage and the preoperative variables analyzed. The operative variables that were found to be associated with lower incidence of leakage at the multivariate analysis (p < 0.05) were the reinforcement of the staple line (or overriding suture or buttressing materials) and the experience of the surgeons. A distance of less than 2 cm from the pylorus resulted to be significantly related to a higher incidence of fistula at the univariate analysis.

Conclusions

In this large consecutive cohort study of LSG, proximal staple line reinforcement (buttress material or suture) reduced the risk of a leak. The risk of a proximal leak was much higher in the surgeons first 100 cases, which has implications for training and supervision during this “learning curve” period.

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Authors and Affiliations

  1. Department of Surgery, S.I.C.OB. (Italian Society of Bariatric Surgery) Referral Center for Bariatric Surgery, Policlinico San Marco, 24040 Zingonia-Osio Sotto, Bergamo, Italy

    Giovanni Cesana, Stefano Cioffi, Riccardo Giorgi, Roberta Villa, Matteo Uccelli, Francesca Ciccarese, Giorgio Castello, Bruno Scotto & Stefano Olmi

  2. University Of Milan, Via Francesco Sforza 35, 20122, Milan, Italy

    Giovanni Cesana, Stefano Cioffi & Stefano Olmi

Authors
  1. Giovanni Cesana
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  2. Stefano Cioffi
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  3. Riccardo Giorgi
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  4. Roberta Villa
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  5. Matteo Uccelli
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  6. Francesca Ciccarese
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  7. Giorgio Castello
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  8. Bruno Scotto
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  9. Stefano Olmi
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Correspondence to Giovanni Cesana.

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The authors declare that they have no conflict of interest.

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Informed consent was obtained from all individual participants included in the study.

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For this type of study formal consent is not required.

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Cesana, G., Cioffi, S., Giorgi, R. et al. Proximal Leakage After Laparoscopic Sleeve Gastrectomy: an Analysis of Preoperative and Operative Predictors on 1738 Consecutive Procedures. OBES SURG 28, 627–635 (2018). https://doi.org/10.1007/s11695-017-2907-z

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  • DOI: https://doi.org/10.1007/s11695-017-2907-z

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