Operative Time in Sleeve Gastrectomy: Influence of Preoperative Factors in Relation to Perioperative Complications

Luciano J Deluca, MD, Patricio J Cal, MD, Tomas C Jakob, MD, Ezequiel O Fernandez, MD. Centro de Rehabilitacion Quirurgica de la Obesidad (CRQO)

INTRODUCTION: There is evidence that surgical time is directly related to perioperative morbidity and mortality. Bariatric surgeries are the most effective treatment for morbid obesity and its co morbidities. Among them, laparoscopic sleeve gastrectomy (LSG) has become a low morbidity procedure with wide acceptance and excellent results.

METHODS AND PROCEDURES: Our goal was to evaluate the relation of surgical time in LSG with preoperative factors such as BMI and preoperative weight loss and its correlation with perioperative morbidity and mortality. Between June 2014 and August 2015, 455 patients undergoing LSG were included. All surgeries were performed by the same two surgeons. Data was collected prospectively. Operative time was measured from placement of the first trocar to extraction of the last one. Anthropometric characteristics, previous abdominal surgery, preoperative weight loss, perioperative complications, perception of difficulty by the surgeon according to dietary preparation and surgical time were evaluated.

RESULTS: Mean BMI was 46.01 kg/m2 (35.3-78.4), mean age was 42.9 (16-74) and 82.6% were women. Preoperative weight loss was 12.2% of initial body weight (2.17-29.6). Average operating time was 30.9 minutes for Surgeon 1 and 31.4 minutes for Surgeon 2 (P = NS). Dividing patients into 4 groups by BMI (<45, 45- <50, 50-55,> 55) operative time was 30.6; 31.7; 30.2 and 33.4 minutes, being the last one significantly longer than the other groups. Dividing patients into 3 groups according to preoperative weight loss (>13%, 10-13% and <10%), surgical time was 30.6; 31 and 32.3 minutes respectively (P = NS). There was no correlation between preoperative BMI or weight loss and surgical time (r = 0.09 and r = -0.02). Surgery in men lasted 34.3 minutes vs. 30.5 in women (P=0.001).There was no significant difference between patients with and without previous surgery (31.1 vs. 31.2). Twelve major complications (2.63%) were recorded in the group (2 leaks, 1 intraabdominal abscess and 9 major bleedings). Surgical time for patients who had complications was 29.6 vs. 31.2 minutes for the uncomplicated (P=NS). When the surgeon's perception of preparation was good, operatory time was 30.5 minutes vs. 32.9 minutes, it was perceived as poor (P = 0.02).

CONCLUSION: Surgery was significantly longer on patients with higher BMI, in men, and in those whose preparation seemed poor. Pre operative weight loss should be emphasized in the super-obese and in men.

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