Joseph Broucek, MD, Chloe Jackson, Mauricia Buchanan, Fernando Elli, MD, Horacio Asbun, MD, John Stauffer, MD, Steven P Bowers, MD. Mayo Clinic Hospital
INTRODUCTION: Laparoscopic sleeve gastrectomy (LSG) has become the most commonly performed procedure in the treatment of morbid obesity, but there is significant variability in its performance. From national database analysis, more restrictive sleeve construction, based on smaller bougie size, has not correlated with greater weight loss. We hypothesize that bougie size is not reflective of actual restriction, or that sleeve restriction does not correlate with weight loss. We performed qualitative and volumetric analysis of immediate post–sleeve contrast studies to determine the association of sleeve restriction with post-operative weight loss and complications.
METHODS: Between 2010 and 2015, 222 patients underwent immediate post-sleeve contrast studies. Based on standardized vertebral body height assessment by preoperative chest radiograph, sleeve diameter at intervals (including the narrowest point) was measured in mm, and the volume above the narrowest point of the sleeve was calculated. Sleeve shape was assumed as dual-tiered or simple truncated cone based on morphology. Sleeve restriction, morphology and volumetric analysis were associated with clinical outcomes including complications, post-op symptoms, and weight loss at 6 months.
RESULTS: The narrowest point of the sleeve was of mean diameter 8.20 mm3, (+/- 4.1mm3). Sleeve restriction was not associated with bougie size (36 Fr,7.25 mm3 vs 42 Fr, 8.43 mm3; p=0.15). There were 13 readmissions (6.8%); readmission was not associated with narrowest point diameter or sleeve volume (p=NS). Obstructive symptoms including reflux occurred in 37%; obstructive symptoms were not associated with sleeve volume (19.2 cm3 with vs 19.1 cm3 without; p=0.92), narrowest point diameter, or sleeve morphology. The mean total body weight loss at 6 months post-op was 30.3%. Neither narrowest point diameter, sleeve volume, nor sleeve morphology correlated to weight loss at 6 months (p=NS). Overall complications and readmission rate did not correlate with sleeve morphology.
CONCLUSIONS: Overall, sleeve volume and restriction does not seem to have an impact on reflux symptoms, weight loss at 6 months, or readmission. We also see no association between bougie size and restriction created or complication rate. This brings to question the importance of sleeve size and overall morphology when performing laparoscopic sleeve gastrectomy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88399
Program Number: P640
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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