Jonathan R Thompson, MD1, Vikrom K Dhar, MD1, Dennis J Hanseman, PhD2, Brad M Watkins, MD1, Tayyab S Diwan, MD1, Thomas Inge, MD, PhD3, John M Morton, MD, MPH4. 1University of Cincinnati College of Medicine, 2SET Data Collaborative, 3Children’s Hospital Colorado and University of Colorado, Denver, 4Stanford School of Medicine
Introduction: Anatomic imperfections in the sleeve gastrectomy pouch have been implicated in increased gastroesophageal reflux disease (GERD) and food intolerance following LSG. Anatomy-based sleeve gastrectomy (ABS) has been developed to improve the shape, volume and anatomic consistency of the laparoscopic sleeve gastrectomy (LSG) pouch. We report our one-year results using an ABS technique.
Methods: A quality improvement data collaborative was initiated with custom fields added to the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Determination of “not human subjects research” was obtained from our IRB. ABS was implemented beginning in 6/2016. ABS consists of planning a sleeve gastrectomy pouch by marking the stomach 1cm from the gastroesophageal junction, 3cm from the IA, and 6cm from the pylorus. The marks are lined up beside a 25cm clamp and a 60mm endocutter is used to resect the stomach. 641 ABS cases were compared to 737 cases where a 40F suction bougie was used for pouch creation (1/2014-5/2016). No programmatic changes were made during this time. 30-day safety, 6-month and 1-year GERD and weight loss outcomes were compared. Students t test and Chi square tests were used as appropriate.
Results: No significant differences in gender, preoperative BMI, or operative time were identified between groups (all p > 0.05). Average age was 45 in the bougie group and 43.5 in ABS (p = 0.02). ABS was associated with shorter length of stay (1.2 vs 1.7, p <0.01), 42% fewer readmissions (3.3% vs 5.7%, p = 0.03), 61% fewer readmissions due to nausea/vomiting (1.1% vs 2.9%, p = 0.02). ABS patients had a 48% lower 6-month GERD rate (21% vs 40%, p < 0.01), 86% higher 6-month GERD resolution rate (54% vs 29%, p <0.01), 49% lower 1-year GERD rate (20% vs 39%, p < 0.01), 106% higher 1-year GERD resolution rate (72% vs 35%, p < 0.01). Both groups had similar 1-year % total weight loss (26.3% vs 27.3%, p = 0.41).
Conclusion: Anatomy-based sleeve gastrectomy offers benefits over sleeve gastrectomy with suction bougie with regard to 30-day safety and dramatic improvement of GERD rates at 6 months and 1 year.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93516
Program Number: P119
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster