Shauna M Levy, MD, MS, Chetan Aher, MD, Matthew D Spann, MD, Wayne J English, MD, D. Brandon Williams, MD. Vanderbilt University Medical Center
Objective: Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric surgical procedure, but the optimal technique for this operation is still unclear. Patient outcomes as well as cost are extremely important considerations in determining the most effective operative technique. Staple line reinforcement is utilized by over 80% of surgeons performing LSG. It is clear that staple line reinforcement with buttress material substantially adds to the cost of the operation, and recent data suggests that outcomes are potentially worse with staple line reinforcement. Most surgeons at our institution do not utilize staple line reinforcement. The objective of this study was to review our 30-day outcomes relating to bleeding and leaks in laparoscopic sleeve gastrectomy patients as these are the two most commonly seen complications with this operation.
Methods: All sleeve gastrectomies performed between January 1, 2014 and July 31, 2016, at Vanderbilt University Medical Center were reviewed and included in the analysis. The operations were performed by five different surgeons. Two surgeons routinely used biologic buttress material with each staple load. The remaining surgeons did not use any staple line reinforcement but used surgical clips or oversewing for hemostasis. Definitions were in accordance with the MBSAQIP data registry.
Results: During this 31-month period a total of 415 laparoscopic vertical sleeve gastrectomies were performed. The median BMI was 46 (range 32 – 95). The median bougie size was 34.5 (range 32-36). Staple line reinforcement was utilized in 19% (N=80) of cases. The staple line was oversewn in 7% (n=31) of cases. Five percent (N=20) of all patients had staple line reinforcement with buttress material and oversewing of the staple line. Amongst all patients, two (0.5%) had post-operative bleeding requiring transfusion, and one of these patients required re-exploration. Neither of these patients had staple line reinforcement with buttress material. None of the patients had a post-operative leak. All patients had 30-day follow-up.
Conclusion: The outcomes in this study were too rare to perform statistical analysis; however, our review of LSG in a large series of patients demonstrates that this can be performed without staple line buttressing with very rare occurrences of bleeding. At our institution, the additional cost of biologic buttress material for each staple is $163 compared to $3.57 per five pack of clips. Performing a LSG without staple line reinforcement using buttressing material could represent a significant cost savings without sacrificing high quality outcomes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80509
Program Number: P536
Presentation Session: Poster (Non CME)
Presentation Type: Poster
