New Method for Evaluating Constrictions in Laparoscopic Sleeve Gastrectomies Used To Study Novel Bougie Device

Matthew S Eschbach, Kristen Langlois, Chris Meehan, Elizabeth Contini, Marisha L Godek, PhD, Andrew Miesse, Dwight G Bronson, MS. Covidien

AIMS: Among surgical weight loss procedures, the laparoscopic sleeve gastrectomy (LSG) has increased in popularity because of its technical simplicity and lower long-term complication rate. Nevertheless, the possibility for leaks and strictures are present and greatly depend on technique and experience in creating the sleeve, especially in the area of the incisura angularis (IA), located on the lesser curvature of the stomach. To examine the constriction of the sleeve, we proposed an evaluation method using a cadaver model. We tested this method during a comparison lab of the sleeve quality of LSGs performed with two different bougies.

METHODS: Two surgeons performed 10 LSGs each on 20 cadaver torsos with cephalad using two 36 Fr bougies, a standard bougie and a Covidien specialty bougie. After the procedure, the stomach sleeve was excised in order to perform the required measurements. The internal diameter of the stomach sleeve was measured along its length at 16 discrete locations in 1 cm increments using a balloon catheter from the EndoFLIPTM system. In order to remove the variability of tissue strength and thickness between subjects, sleeve diameters were recorded immediately after the sleeve began to deform from the inflation of the balloon catheter. A novel metric, referred to as constriction percentage, was used to normalize and compare the amount of constriction between sleeves in the area of the IA.

RESULTS: The specialty bougie had a standard deviation of 6.58 Fr compared to 10.10 Fr of the standard bougie, which demonstrated its lower deviation in diameter throughout the sleeve (p<0.001). There was a significant difference in constriction percentage between the specialty and standard bougie devices, 10.7% and 20.9%, respectively (p<0.001).

CONCLUSIONS: Lower standard deviation of the diameter and less narrowing at the IA when using the specialty bougie promoted a more consistent sleeve formation. This method to evaluate LSGs provided insight into the shape of a completed sleeve and the potential for narrowing of the sleeve in the location of the IA. Comparison of the two bougies using this method presented its ability to compare not only medical devices, but potentially for new surgical techniques and training.

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