James A Radford, DC, MS1, Aliu Sanni, MD2. 1Philadelphia College of Osteopathic Medicine, 2Augusta University
INTRODUCTION: Morbid obesity has become a worldwide major health hazard. The only proven effective treatment is bariatric surgery. The gastric bypass was considered the gold standard but recently sleeve gastrectomy Is increasingly been performed with results demonstrating less complications and similar weight loss to the gastric bypass. Typically, a calibration bougie or orogastric tube is utilized to size the gastric sleeve prior to resection. The optimal size has been a subject of discussion, with advocates for either a larger or smaller sleeve to achieve the best outcomes. The aim of this study is to evaluate the ideal bougie size for best postoperative outcomes following a sleeve gastrectomy.
METHODS: A systematic review was conducted through PubMed to identify relevant studies from January 2008 through December 2016 with comparative data on differing bougie sizes used during laparoscopic sleeve gastrectomy. The primary outcomes assessed included % excess weight loss (%EWL) and postoperative complications (postoperative bleeding, staple line bleeding, staple line leak and postoperative nausea and vomiting). Secondary outcomes were comorbidity resolution (hypertension, diabetes mellitus type 2) and length of hospital stay. Results are expressed as standard difference in means with standard error. Statistical analysis was done using fixed-effects meta-analysis to compare the mean value of the separate groups (Comprehensive Meta-Analysis Version 3.3.070 software; Biostat Inc., Englewood, NJ).
RESULTS: Six studies were quantitatively assessed and included for meta-analysis. Among the studies, 238 patients underwent a laparoscopic sleeve gastrectomy using a bougie size 32F and smaller; and 241 patients underwent a laparoscopic sleeve gastrectomy using a bougie larger than 32F.
There were no significant differences in post-operative outcomes between patients that underwent sleeve gastrectomy with either bougie sizes as it relates to %EWL (0.060, 0.092, P=0.511), post- operative complications (-0.042, 0.092, P=0.648), hospital stay (0.104, 0.107, P=0.334) and comorbidity resolution (0.084, 0.264, P=0.750).
CONCLUSIONS: The use of a bougie size bigger or smaller than 32F for sleeve gastrectomy showed no difference in postoperative outcomes following sleeve gastrectomy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80003
Program Number: P578
Presentation Session: Poster (Non CME)
Presentation Type: Poster