Does the surgeon experience interfere with the leak rate after Laparoscopic Sleeve Gastrectomy ?

Patrick Noel, MD, Marius Nedelcu, MD. Private Hospital La Casamance, Aubagne , Marseille, France.

Introduction: Laparoscopic Sleeve Gastrectomy (LSG) is becoming a very common bariatric procedure, based on several advantages it carries over more complex bariatric procedures. LSG is generally considered a straightforward procedure, but the surgical technique is one of the major determinants of the most feared complication- staple line leak.

Methods: The purpose of this study was to analyze the correlation between the surgeon’s experience and the leak rate and to assess different risk factors for developing gastric leak after LSG. We reviewed a single surgeon’s experience since the introduction of LSG (1500 procedures), we compared yearly the leak rate and analyzed for possible risk factors.

Results: A total of 1500 LSG was performed in La Casamance Private Hospital between september 2005 and july 2013. Eighteen cases (1.2%) of gastric fistula were recorded. Of these, 17 patients were women (94.4%) with a mean age of 39.4 years (range 22-61) and mean BMI of 41.2 kg/m2 (range 34.8-57.1). On an yearly basis, the leak rate was 2.63% (2006), 5.66% (2007), 0%(2008), 2.55% (2009), 1.63% (2010), 0.81% (2011), 0.3% (2012), 0.37% (2013). In group A (the first 750 cases) there were recorded 16 cases of gastric leak and in group B (the last 750 cases) ???. Using Fisher’s Exact Test between the 2 groups, the recorded p- value was 0.0012. Only one leak was recorded in the superobese patients (5.5%) with no statistical difference versus general population with super-obesity (182 cases – 12.1%).

Conclusions : The LSG can be performed safely with a low complication rate. Even if LSG is considered a technically simple bariatric procedure, still, the most feared complication remains the gastric fistula. This review of a large series of a single surgeon’s experience demonstrated that the leak rate after LSG could be significantly reduced by surgeon’s experience.

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