Adel Alhaj Saleh, MD, Michal R Janik, MD, Rami R Mustafa, MD, Mohammed Alshehri, MD, Mohammad Kalantar Motamedi, MD, MPH, Adil Khan, MD, Indravadan Patel, MD, Shiraz Rahim, MD, Mujjahid Abbas, MD, Leena Khaitan, MD, MPH. University Hospitals
Introduction: Sleeve gastrectomy (SG) is one of the most common procedures performed for weight loss. Many seek the “perfect sleeve” with the notion that the type of calibrating device affects sleeve shape, and this in turn will affect outcomes and complications. Two major concerns after SG are amount of weight loss and acid reflux. Our aim was to determine if the various calibration methods could impact sleeve shape and thereby allow for better outcomes of weight loss and reflux.
Methods: A retrospective chart review was performed of 210 patients who underwent SG and had postoperative upper gastrointestinal study (UGI) from 2011 to 2015 in a single center. Data regarding demographics, calibrating devices and clinical outcomes at 1 year (weight loss and de-novo acid reflux) were collected.
UGIs were reviewed by two radiologists blinded to the clinical outcomes. Sleeve shape was classified according to a previously described classification as tubular, dumbbell, upper pouch or lower pouch. The types of calibrating devices used to guide the sleeve size intra-operatively, were endoscopy, gastric tube (Ewald) and fenestrated suction tube (VisiGi). Comparisons were determined by Fisher’s exact test and logistic regression.
Results: One hundred and ninety nine patients met inclusion criteria (11 had no esophagram). Demographics revealed age 45.76 + 10.6 years, BMI 47+ 8.6 kg/m2, and 82% female. Calibration devices used were endoscopic guidance (7.58%), Ewald tube(41.4%), and fenestrated suction tube (Visigi 50.5%). Sleeve shape was reported as 32.6% tubular, 20.6 % dumbbell, 39.2% lower pouch and 7.5% upper pouch (100% interrater reliability). No correlation with type of calibration. 38.6% of patients had <50% excess weight loss at 1 year. 23% of patients remained on PPI at 1 year (of which 43.3% did not have reflux preoperatively) with no correlation with sleeve shape (p=0.7). No association noted between weight loss and sleeve shape (P=0.337). A trend toward less de-novo acid reflux was noted in patients with lower pouch shape.
Conclusion: This study showed no association between sleeve shape and calibration device as well as no difference in clinical outcomes related to the shape of the sleeve. This suggests that the sleeve shape and the type of calibrating device are not as important as bariatric surgeons may think. Patient factors may impact outcomes more than the shape of the sleeve. Other factors should be the focus for predicting desired outcomes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80749
Program Number: S126
Presentation Session: Bariatric surgery – Sleeves, Conversions and More
Presentation Type: Podium