Bougie caliber effect on excess body weight loss and post-operative complications following laparoscopic sleeve gastrectomy: a 1-year follow-up

Mark Jonker, MD, Jonathan Miller, BS, John Kelly, MD, Donald Czerniach, MD, Philip Cohen, MD, Richard Perugini, MD. University of Massachusetts Medical School

Introduction: Laparoscopic sleeve gastrectomy (LSG) has become the most commonly performed weight loss operation in recent years. When compared to Roux-en-Y gastric bypass, there is a theoretical reduction in long term complications such as bowel obstruction, vitamin deficiency, and anastomotic ulceration. LSG appears to be associated with a higher rate of staple line leak. While there is no accepted standard technique for LSG, there is a suggestion that use of a Bougie ≥ 40-Fr is associated with a lower risk of staple line leak. The aim of this study was to determine the effect of bougie caliber on weight loss and immediate post-operative complications following LSG.

Methods: All individuals who underwent LSG at our institution from July 2010 to June 2014 were entered into a database. Data included demographics (age, gender, weight, BMI, EBW), comorbidities (hypertension, type 2 diabetes mellitus, hypercholesterolemia, esophageal reflux disease, obstructive sleep apnea), metabolic profiles (fasting insulin and glucose, Homeostatic model of assessment, Hemoglobin A1c), postoperative length of stay (LOS), complications, and readmission. We followed percent excess body weight loss (%EBW) at follow-up. We analyzed data by dividing patients into two groups based on the size of the Bougie used during the operations [40-Fr (N=60) and ≤38-Fr(N=285)]. Data was compared via T-test.

Results: There were no significant differences between the 2 groups in regards to age, gender, preoperative weight, or BMI. There were no statistically significant differences between the 40-Fr and ≤38-Fr Bougie groups in post-operative bleeding (10.0 vs. 5.3%), leak (0.0 vs. 1.4%), nausea/vomiting (18.3 vs. 10.2%), or readmission (6.7 vs. 5.6%). The %EBW differed significantly between the 2 groups at 6-month follow-up but not at other time points (table).

40-Fr ≤38-Frp value
%EBW±SD at post-operative times for 40-Fr and ≤38-Fr Bougie groups
2 weeks13.7±3.612.6±4.40.069
6 weeks21.6±5.923.0±6.20.150
6 months39.0±12.645.0±12.9*0.017
1 year43.6±7.251.2±20.40.276

Conclusions: Using a 40-Fr bougie for LSG had no impact on short-term post-operative morbidity in this series. No staple line leaks occurred when the larger Bougie was used, though this finding is not significant and may be due to small sample size. Use of 40-Fr Bougie is associated with lower %EBW at six months postoperatively. Continued follow-up of this data will determine if these trends are significant, and, if so, suggest a trade-off between risk of leak and %EBW lost postoperatively.

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