• Skip to main content
  • Skip to header right navigation
  • Skip to site footer

Log in
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
www.sages.org

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Awards
    • Who Is SAGES?
    • Leadership
    • Our Mission
    • Advocacy
    • Committees
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Committee Rosters
      • SAGES Past Presidents
  • Meetings
    • SAGES NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2026 Scientific Session Call for Abstracts
      • 2026 Emerging Technology Call for Abstracts
    • CME Claim Form
    • SAGES Past, Present, Future, and Related Meeting Information
    • SAGES Related Meetings & Events Calendar
  • Join SAGES!
    • Membership Application
    • Membership Benefits
    • Membership Types
      • Requirements and Applications for Active Membership in SAGES
      • Requirements and Applications for Affiliate Membership in SAGES
      • Requirements and Applications for Associate Active Membership in SAGES
      • Requirements and Applications for Candidate Membership in SAGES
      • Requirements and Applications for International Membership in SAGES
      • Requirements for Medical Student Membership
    • Member Spotlight
    • Give the Gift of SAGES Membership
  • Patients
    • Join the SAGES Patient Partner Network (PPN)
    • Patient Information Brochures
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find A SAGES Surgeon
  • Publications
    • Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Sustainability in Surgical Practice
    • SAGES Stories Podcast
    • Patient Information Brochures
    • Patient Information From SAGES
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • MesSAGES – The SAGES Newsletter
    • COVID-19 Archive
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • Avoid Opiates After Surgery
    • SAGES Subscription Catalog
    • SAGES TV: Home of SAGES Surgical Videos
    • The SAGES Safe Cholecystectomy Program
    • Masters Program
    • Resident and Fellow Opportunities
      • MIS Fellows Course
      • SAGES Robotics Residents and Fellows Courses
      • SAGES Free Resident Webinar Series
      • Fluorescence-Guided Surgery Course for Fellows
      • Fellows’ Career Development Course
    • SAGES S.M.A.R.T. Enhanced Recovery Program
    • SAGES @ Cine-Med Products
      • SAGES Top 21 Minimally Invasive Procedures Every Practicing Surgeon Should Know
      • SAGES Pearls Step-by-Step
      • SAGES Flexible Endoscopy 101
    • SAGES OR SAFETY Video Activity
  • Opportunities
    • Fellowship Recognition Opportunities
    • SAGES Advanced Flexible Endoscopy Area of Concentrated Training (ACT) SEAL
    • Multi-Society Foregut Fellowship Certification
    • Research Opportunities
    • FLS
    • FES
    • FUSE
    • Jobs Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • OWLS/FLS
You are here: Home / Abstracts / Specimen Extraction after Laparoscopic Sleeve Gastrectomy: No Need to Bag It.

Specimen Extraction after Laparoscopic Sleeve Gastrectomy: No Need to Bag It.

Eric Boyle, MD, Timothy Kuwada, MD, Dimitrios Stefanidis, MD, PhD, Keith Gersin, MD

Carolinas Medical Center

Background: Laparoscopic sleeve gastrectomy (LSG) is an effective and popular bariatric procedure. In contrast to the adjustable gastric band and gastric bypass, LSG is a resectional procedure that requires removal of the relatively large gastric remnant. This often requires enlargement of a trocar site and the potentially contaminated specimen may increase the incidence of wound infection. Various techniques have been described to extract the remnant, many of which incorporate the use of a “protective” extraction bag. However, an extraction bag increases cost and may require a larger fascial incision due to bunching of the specimen, thus increasing pain and the risk of incisional hernia. The purpose of our study is to describe our technique and outcomes for bagless extraction of the stomach during LSG.

Methods: A single center, retrospective review of prospectively collected data from a consecutive series of non-revisional laparoscopic sleeve gastrectomies from 2008-2012 (3 surgeons). Wound infection and cost savings were the primary outcome of interest. Patient demographics, reoperation, leak, incisional hernia and mortality were secondary outcome measures. Disruption (spillage) of the gastric specimen was tracked in 135 consecutive patients by a single surgeon. All patients received 2 gm of intravenous Ancef within 30 minutes of skin incision, but routine postoperative antibiotics were not administered. The resected stomach was extracted at the 15 mm port site by enlarging the fascial defect to approximately 2 cm. The gastric specimen was grasped with a Kelly clamp at the corner of the first antral staple line and gently removed. The fascia was closed with a laparoscopic suture passer (figure of eight absorbable 0 suture). The skin was closed using interrupted 4-0 monocryl suture. The patient’s incisions were evaluated two weeks after surgery by their attending surgeon.

Results: There were a total of 273 patients who underwent LSG during the study period. The mean age, weight and BMI was 44.1 years, 269.6 pounds, and 43.9 respectively. Females comprised 82% of the patients. The overall wound infection rate for the study group was 1.46% (4/273). All wound infections were managed at the bedside with incision and drainage. Four patients (3%) had disruption and spillage from the gastric specimen during extraction. There were no wound infections in these four patients. There were no reoperations, incisional hernias, staple line leaks or deaths. By eliminating the use of a 15mm laparoscopic retrieval bag (Covidien Endocatch II #173049), our hospital saved over $58,000 ($213 USD per bag) in equipment costs.

Conclusion: In our series, removal of the stomach through the 15 mm port site, without an extraction bag, was associated with a low wound infection rate and appreciable cost savings. The incidence of specimen disruption with this technique was low (3%) and did not appear to increase the incidence of wound infection. The potential for reduced pain and incisional hernia by avoidance of a bigger extraction incision due to bunching of the specimen in the extraction bag requires further study.


Session: Podium Presentation

Program Number: S012

856

Share this:

  • Click to share on X (Opens in new window) X
  • Click to share on Facebook (Opens in new window) Facebook
  • Click to share on LinkedIn (Opens in new window) LinkedIn
  • Click to share on Pinterest (Opens in new window) Pinterest
  • Click to share on WhatsApp (Opens in new window) WhatsApp
  • Click to share on Reddit (Opens in new window) Reddit
  • Click to share on Pocket (Opens in new window) Pocket
  • Click to share on Mastodon (Opens in new window) Mastodon
  • Click to share on Threads (Opens in new window) Threads
  • Click to share on Bluesky (Opens in new window) Bluesky

Related


sages_adbutler_leaderboard

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064

1-310-437-0544

[email protected]

Monday – Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Bluesky
  • X
  • Instagram
  • Facebook
  • YouTube

Copyright © 2025 · SAGES · All Rights Reserved

Important Links

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals