Kate Pawloski, MD, Michael Fastiggi, MD, Leslie James, BA, Linda Zhang, MD, Edward Chin, MD, Scott Nguyen, MD. Icahn School of Medicine at Mount Sinai
Introduction: Endoscopy is commonly performed during sleeve gastrectomies to evaluate the staple line and assure hemostasis. Many surgeons advocate for its routine use to inspect for leaks and bleeding, which carry significant morbidity and mortality. We aimed to determine the rate of endoscopic identification of staple-line complications and to assess its impact on operative time.
Methods and Procedures: An IRB-approved retrospective review of 368 patients who underwent sleeve gastrectomies between 2009-2017 was performed. Outcomes were collected. The length of operative time of LSG+endoscopy vs. LSG alone was compared using a two-tailed t-test. The rate of positive endoscopic findings was calculated.
Results: Of 368 patients, 85.87% (n=316) had endoscopies. No leaks or bleeding were visualized. Four patients (1.27%) re-presented with leaks and three patients (0.82%) experienced bleeding necessitating reoperation. All patients with complications had normal endoscopies. There was a statistically significant difference in mean operative time between groups (p<0.0001).
Table 1:
| LSG+endoscopy | LSG | p-value | |
| Cases | 316 | 52 | |
| Mean age | 40.0 | 42.1 | |
| Female | 261 (82.6%) | 46 (88.5%) | |
| Mean pre-operative BMI | 44.6 | 44.7 | |
| Cormorbidities | |||
| HTN | 150 (47.5%) | 25 (48.1%) | |
| HLD | 51 (16.1%) | 15 (28.9%) | |
| T2DM | 89 (28.2%) | 9 (17.3%) | |
| OSA | 95 (30.0%) | 24 (46.2%) | |
| GERD | 29 (9.2%) | 11 (21.2%) | |
| Endoscopic findings | |||
| Positive | 0 | N/A | |
| Negative | 316 (100%) | N/A | |
| Mean operative time (mins) | 134 | 107 | <0.0001 |
| Leak | 4 (1.27%) | 0 | |
| Mean time to leak (days) | 12.75 | N/A | |
| Bleed | 3 (0.82%) | 0 | |
| Mean time to bleed (days) | 4.33 | N/A |
Conclusion: Leaks and hemorrhage are early postoperative complications that are not seen intraoperatively in our experience. Furthermore, endoscopy significantly increases mean operative time. Routine use should be left to the discretion of the surgeon but should not be considered an essential step of the sleeve gastrectomy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87265
Program Number: P594
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster