Ghaith Khair, MD, FACS, Anne Sill, MSHS, Andrew Averbach, MD, FACS, FASMBS. Saint Agnes Healthcare
Background: According to ASMBS estimate for 2017, LSG constituted over 60% of all bariatric procedures. Between 2011 and 2017 the leak rate has decreased from 2% and currently stabilized at 0.3%. A variety of ILT is used, in order to prevent the most serious complications of this procedure. Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data indicate that ILT is performed in three quarters of LSG cases. However, at present the effectiveness of ILT in improving outcomes is still unclear.
Methods: MBSAQIP 2015-2016 Participant Use File (PUF) data were used to select only primary LSG cases. Two study groups were based on the use of ILT, and multiple primary outcomes were compared using Chi-square tests and T-tests. Leak rate was calculated based on several reported outcomes. Data set reflected only the fact that ILT was performed without definition of the particular variant.
Results: A total number of 185,867 primary LSG were performed; 143,400 patients (77.2%) had ILT and 42,467 patients (22.8%) did not. The post-operative leak rate was similar (0.3% – with ILT and 0.2% – with no ILT; P = 0.367). There were no statistical differences between study groups in rates of mortality, overall morbidity, re-operation, reintervention and hospital readmission. In cases with no ILT, bougie size of Fr 40 or higher were used more frequently with average size of 37.1+8.1 Fr compared to 36.8+8.4 Fr in ILT group. OR time was significantly increased in ILT group (76.7+32.7 min vs 68.6+32 min; P<0.001).
| Variable | No ILT | ILT performed | P value |
| Number of patients | 42,467 (22.8%) | 143,400 (77.2%) | |
| Bougie size <40 Fr | 67.5% | 72.3% | <0.001 |
| Bougie size >40 Fr | 32.5% | 27.7% | |
| Average bougie size Fr | 37.1+8.1 | 36.8+8.4 | <0.001 |
| OR time min. | 68.6+32 | 76.7+32.7 | <0.001 |
| Hospital LOS days | 1.62+1.4 | 1.64+1.5 | 0.001 |
| Mortality | 0.1% | 0.1% | 0.850 |
| Overall morbidity | 4.6% | 4.6% | 0.467 |
| Leak postop | 0.2% | 0.3% | 0.367 |
| Reoperation | 0.9% | 0.8% | 0.126 |
| Reintervention | 0.9% | 1.0% | 0.047 |
| Readmission | 3.3% | 3.2% | 0.357 |
Conclusion: The routine use of ILT in LSG is not associated with reduced leak rates or with improved 30-day outcomes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 92278
Program Number: P188
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster