Vikrom K Dhar, MD1, Justin T Graff, BS1, Dennis J Hanseman, PhD1, Brad M Watkins, MD1, Tayyab S Diwan, MD1, John M Morton, MD2, Jonathan R Thompson, MD1. 1University Of Cincinnati, 2Stanford University
Background: Variability in surgical technique resulting in narrowing at the incisura angularis, twisting along the staple line, and retention of the gastric fundus has been implicated in increased gastroesophageal reflux disease (GERD) following laparoscopic sleeve gastrectomy (LSG). Standardizing creation of the sleeve based on anatomic landmarks may help produce more consistent sleeve anatomy and improve outcomes.
Methods: A retrospective review of all patients undergoing LSG from January 2016 to November 2016 at a single institution specializing in bariatric surgery was performed (n=271). Patients underwent either traditional LSG with use of a 40F suction bougie to guide creation of the sleeve (n=156) or anatomy-based sleeve gastrectomy (ABS, n=115). ABS was performed using a gastric clamp to maintain predetermined distances from key landmarks (1 cm from gastroesophageal junction, 3 cm from incisura angularis, 6 cm from pylorus) during stapling. Patient demographics, perioperative characteristics, and post-operative outcomes were compared using chi-square and student’s t-tests as required.
Results: No significant differences in age, gender, preoperative BMI, or operative time were identified between groups (all p > 0.05). Similarly, for patients with 6 month follow up, there was no significant difference in prevalence of GERD preoperatively (ABS, 29% vs. bougie, 36%; p = 0.364) There were no intraoperative complications, reoperations, leaks, or bleeds in either cohort. No significant difference in percent excess weight loss at 6 months was found (ABS, 48.2% vs. bougie, 50.9%; p = 0.374). Overall, patients undergoing ABS had a significantly lower rate of GERD at least 6 months post-operatively compared to the bougie group (12% vs. 26%; p = 0.037). In patients without pre-operative GERD, there was no significant difference in the rates of new-onset GERD at least 6 months following LSG (ABS, 9% vs. bougie, 11%; p = 0.659). For patients with pre-operative GERD, those undergoing ABS achieved significantly higher rates of GERD resolution (ABS, 79% vs. bougie, 49%, p = 0.030).
Conclusion: Standardization of surgical technique by utilizing anatomic landmarks during sleeve creation significantly reduces GERD following LSG.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87399
Program Number: P642
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster