Extraction of gastric remnant during a laparoscopic sleeve gastrectomy without an extraction bag

Abraham Krikhely, MD, Sameer Alrefai, MD, Jenny Choi, MD, Anirban Gupta, MD, Pratibha Vemulapalli, MD, Diego Camacho, MD

Montefiore Medical Center

Background:
Sleeve gastrectomy has become increasingly popular as a stand-alone bariatric procedure over the past decade. Many bariatric surgeons use an extraction bag for extraction of the gastrectomy specimen with the theoretical benefit of decreased wound infection rate at the extraction site. There is limited data to support this practice, yet the device adds cost and time to the operation. The high volume bariatric surgical group at our institution had adopted the practice of removing the gastric remnant without an extraction bag over the past few years. We decided to look at our practice to see our rate of wound infection without the use of the extraction bag

Methods:
This is a retrospective analysis of a single center large volume bariatrics experience. The ACS Bariatric Surgery Center Network was queried to identify all sleeve gastrectomies done at this center since 2010. The operative note was reviewed to determine if an extraction bag had been used. Inpatient, emergency room and outpatient records were then reviewed to identify post-op wound infections at the surgical extraction site. Wound infection was defined as the wound requiring either re-opening or antibiotics, as determined by the physician who assessed the wound.

Results:
Between early 2010 and July 2012, 314 sleeve gastrectomies were identified. Of these, in 275 cases the gastric remnant was removed without the use of an extraction bag. 39 cases were done with the use of an extraction bag. Use of the extraction bag was largely based on surgeon preference and 36 of the 39 were from a single surgeon before that surgeon changed practice to not using an extraction bag. 8 of the cases done without an extraction bag developed a wound infection at the extraction site (2.9%) and none of the cases done with an extraction bag developed an infection. The difference was not statistically significant. One of the patients with wound infection was also treated for a liver abscess and recovered after a prolonged hospital course, and the other seven patients were successfully treated with local wound care and/or a short course of oral antibiotics.

Conclusions:
This data suggests that the removal of the gastric remnant without an extraction bag is a generally safe practice with low infection rates.

Session: Posters/Distinction

Program Number: P010