Vanessa Falk, David Pace, Laurie Twells, Chris Smith, Darryl Boone, Raleen Murphy, Kendra Lester, Debbie Gregory. Memorial University of Newfoundland
Newfoundland is a small province with the highest rate of obesity and associated comorbidities among Canadian provinces. The provincial bariatric surgery program has performed laparoscopic sleeve gastrectomy (LSG) since 2011. This retrospective study aims to examine our center’s 30-day postoperative complication rates.
Between May 2011 and December 2013, 188 patients underwent LSG. Three bariatric surgeons carried out all procedures. A chart review was conducted to examine patient demographics and 30-day post-operative complications. Statistical analysis was performed in SPSS (Version 21).
All procedures were successfully completed laparoscopically. No mortalities occurred. The mean age of this population was 43.4 years (range 22-70 years) with 81.9% of patients being female. The mean preoperative BMI was 49.3 kg/m2 (range 35.4 k- 67.4 kg/m2). Obesity- related comorbidities included hypertension (54.3%), obstructive sleep apnea (46.3%), diabetes (37.8%), gastroesophageal reflux (36.2%), documented cardiovascular disease (4.8%), osteoarthritis (36.7%), and dyslipidemia (36.7%). Furthermore, 36.7% of patients reported a psychiatric diagnosis such as depression and anxiety.
The mean length of stay was 2.18 days (range 1-16 days). The overall 30-day complication rate was 14.9%. Major complications included four patients with bleeding requiring blood transfusions (2.1%), one stricture (0.5%) successfully treated with a single bougie dilation, two patients with a pulmonary embolus (1.1%) and three patients with staple line leaks (1.6%), one of which required early re-operation and one treated with endoscopic stenting. Minor complications included urinary retention (one patient), dehydration necessitating intravenous fluids (four patients), two patients developed a rash treated with medications (1.1%), and 11 patients (5.9%) had a post-operative course complicated by infection, including superficial wound infection, otitis media, and UTI. Frequency of gastrointestinal reflux increased from 36.2% to 44.7% (p-value= 0.051) post LSG.
The overall complication rate in this study is similar to published data from larger academic centers (0 to 29%). The current leak rate of 1.6% is well within the up to 5% quoted in the literature. This study supports the performance of bariatric surgery within small centers.