Arianne T Train, DO, MPH, Steven D Schwaitzberg, MD, MA, Aaron B Hoffman, MD. The State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences
Introduction: Sleeve gastrectomy recently surpassed gastric bypass as the most commonly performed bariatric procedure worldwide, however there remains potential for a large degree of variation in technique and gastric pouch characteristics. We describe a new technique for completion of the vertical sleeve gastrectomy that may be helpful in reducing post-procedure anatomic variation.
Methods: Gastroepiploic and short gastric vessels along the greater curvature are divided using standard technique and the gastro-esophageal (GE) junction is exposed. Landmarks are identified and marked: 6 cm from the pylorus, 3 cm from the incisura, and 1 cm from the GE junction. The Standard Clamp (Standard Bariatrics, Cincinnati, OH) is placed across the stomach along an oblique line connecting these three landmarks with the tip and handle of the clamp in approximately the 1 o’clock and 7 o’clock positions, respectively. An 18 French oro-gastric tube is guided into the pylorus along the lesser curvature adjacent to the clamp. A vertical sleeve gastrectomy is then performed to the anatomic left of the clamp using a single gold followed by several blue loads of the Ethicon Echelon GST endocutter.
Results: Beginning in October 2017, approximately 150 patients have undergone laparoscopic sleeve gastrectomy using this technique. Adherence to ideal parameters for performing a sleeve gastrectomy has been achieved in each case: this includes stapling distances 4-6 cm from the pylorus, 2-3 cm from the incisura, and 1 cm from the GE junction with a staple line that is not twisted or deflected, as twisting of the pouch has been implicated in postoperative reflux and staple-line leaks due to high intragastric pressures. Visual inspection of this series of gastric pouches reveals a uniform curved appearance, and measured deflection angle of the specimen tip has been 0 degrees in each case. In our experience, this contrasts with approximately 15-90 degrees of twist observed in even well-formed classic sleeve gastrectomies performed using a bougie. There have been no intra-operative complications attributable to the use of this device. Routinely, patients tolerate bariatric clear liquids and protein shakes on the same day of surgery and are discharged on postoperative day 1.
Conclusion: The Standard Clamp technique is simple and feasible. Use of this technique has resulted in visually uniform postoperative gastric pouches with consistent adherence to ideal anatomic parameters. The Standard Clamp may be a helpful tool in decreasing variation and undesirable pouch characteristics in sleeve gastrectomy procedures.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95453
Program Number: V058
Presentation Session: Exhibit Hall Theater Video Session II
Presentation Type: EHVideo