Seyed Mohammad Kalantar Motamedi, MD, MPH1, Rami R Mustafa, MD1, Gwen Bonner, MD1, Amir Kasaeian, PhD2, Mujjahid Abbas, MD1, Tomasz Rogula, MD1, Leena Khaitan, MD, MPH1. 1University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA, 2Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Introduction: There has been debates on the effectiveness of staple line reinforcement (SLR) in prevention of leaks in bariatric surgeries specifically Laparoscopic Gastric Sleeve (LGS). The earlier analysis of national data from Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) 2010-2014 was showing that at patient level, the SLR is increasing the rate of the leaks.(1) However it decreased the bleeding rate.
Method: We used the most recent national data from MBSAQIP 2015(2). Univariate analysis and adjusted hierarchical logistic regression model were implemented to evaluate association of leaks with patient related factors as well as operation related measures. Patients with any missing data were excluded from the model.
Results: Out of 168093 patients in MBSAQIP 2015 data 98292 (58.5%) had LSG. Data was available for 58876 (59.9%) cases of which 39504 (67.1%) had received SLR. In adjusted model, leaks were only associated with factors (Odds ratio, P-value) such as anticoagulation therapy (5.89, 0.003), history of previous surgery (1.95, 0.24) and bleeding (1.99, <.001). Each 10 minutes increase in operation length was associated with 5% increase in leak (P-value = <.001).
Also bleeding was only associated with anticoagulation therapy (4.5, <.001), staple line check with provocative test (0.63, .001), drain placement (1.4, .008), hyperlipidemia (1.6, <.001) and history of GERD (1.4, .008).
Each 10 minutes increase in operation length was associated with 3% increase in probability of bleeding (P-value = 0.02).
SLR was not associated with leaks (p-value=0.75) or bleeding (P-value=0.4) in adjusted model.
Conclusion: We found no evidence that SLR procedure might either decrease or increase the incidence of major complications such as bleeding or leaks in laparoscopic sleeve gastrectomy. This finding differs from the previous MBSAQIP results for leaks. Provocative leak test is protective against bleeding by 37%. Operative time was associated with increased risk for both leaking and bleeding.
References:
1. Berger ER, Clements RH, Morton JM, Huffman KM, Wolfe BM, Nguyen NT, et al. The impact of different surgical techniques on outcomes in laparoscopic sleeve gastrectomies: the first report from the metabolic and bariatric surgery accreditation and quality improvement program (MBSAQIP). Annals of surgery. 2016;264(3):464-73.
2. MBSAQIP Participant Use Data File (PUF): American College of Surgeons; 2017 [cited 2017 1/7/2017]. Available from: https://www.facs.org/quality-programs/mbsaqip/participant-use.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88102
Program Number: P647
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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