Chemical pyloroplasty with botulinum toxin (Botox(r)) during sleeve gastrectomy – A retrospective analysis of staple-line leak rates

Robert C Perez, MD, Vladimir Davidyuk, MD, Jason J Arellano, MD, T. Paul Singh, MD, Brian R Binetti, MD, Daniel J Bonville, DO, Steven C Stain, MD. Albany Medical Center

INTRODUCTION: Sleeve gastrectomy has become a leading procedure for the treatment of morbid obesity.  Staple-line leaks remain one of the most concerning complications following sleeve gastrectomy.  It is believed that increased pressure within the sleeve leads to the occurrence of staple-line leaks.  Improved gastric emptying by means of pyloroplasty should reduce intragastric pressure.  The purpose of this study was to compare the incidence of staple-line leak in patients who did and did not receive chemical pyloroplasty via pyloric botulinum toxin (Botox®) injection during sleeve gastrectomy. 

METHODS AND PROCEDURES: This is a retrospective analysis of 281 patients who received either robotic or laparoscopic sleeve gastrectomy at our institution from August 2009 to July 2013.  Demographic, peri-operative and post-operative data were collected from the patients’ electronic health record (SOARIAN). 

RESULTS: A total of 281 patients underwent sleeve gastrectomy from August 2009 to July 2013.  198 (70%) patients received chemical pyloroplasty with pyloric Botox® injection.  Mean BMI in this group was 45.0±6.9 with an average age of 43.2±10.9.  83 (30%) patients did not receive chemical pyloroplasty.  Mean BMI in this group was 44.6±6.6 with an average age of 45.8±11.4.  There was no significant difference in mean BMI, age, or gender make up between the two groups.  There was no incidence of leak in the group that received Botox® for chemical pyloroplasty.  The incidence was 2.41% (2/83) in patients who did not receive Botox® (p<0.05).   

CONCLUSIONS: Chemical pyloroplasty with pyloric Botox® injection is effective in reducing staple-line leaks when used during sleeve gastrectomy.  It is a simple, effective method to prevent leak by improving gastric emptying.  Further research will evaluate the efficacy of Botox® injection on other indicators such as hospital length of stay and readmission rates.

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