Standardized protocol utilization decreases rate of complications: A study of laparoscopic sleeve gastrectomy in 189 consecutive patients.

Carlos A Macias, MD, MPH, Bryan Sandler, MD, Juan S Barajas-Gamboa, MD, Manuel Valero, MD, Joslin Cheverie, MD, Mark A Talamini, MD, Santiago Horgan, MD, Garth R Jacobsen

University of California San Diego

Introduction. Longitudinal sleeve gastrectomy (LSG) has increasingly been used as the primary treatment for morbid obesity. Two potential major potential complications are leak and bleeding at the gastric resection line. The aim of our study was to assess weight loss, resolution of comorbid conditions, as well as examine the mortality and morbidity among patients who underwent a LSG using standardized steps in order to prevent leaks and bleeding: a bioabsorbable reinforcement at the staple line and a 2-0 silk suture imbricating the resected gastric border with application of a fibrin sealant.

Methods. This is a retrospective review of consecutive patients undergoing laparoscopic sleeve gastrectomy at our institution. All procedures were performed by 3 surgeons following the same laparoscopic technique: a bioabsorbable staple line reinforcement (W.L. Gore & Associates, Inc, Newark, DE), a 2-0 running silk suture imbricating the resected gastric border, a fibrin sealant application (Omrix Biopharmaceuticals S.A., Somerville, New Jersey, USA) over a standard gastroscope as a Bougie, and lastly endoscopic inspection of the suture line at scope withdrawal. We analyzed age, gender, BMI, operative time, intraoperative complications, postoperative complications, length of stay and ICU admission.

Results. Between May 2007 and July 2012, 189 patients underwent LSG. Mean age was 45.7 years, and most were female (79%). Average initial BMI was 46.1 ± 8.7 kg/m2. Mean operative time was 103 minutes. Three patients (1.5%) had bleeding in the immediate postoperative period requiring blood transfusions and ICU admission, 2 returned to the OR for bleeding from the short gastric vessels. One patient had a leak (0.5%). There were no mortalities and no late complications. Mean follow up was 13.6 months (range 1 to 43 months). Latest BMI after surgery was 36.4 ± 8.6 kg/m2; the percentage excess weight loss was 42.8 ± 21.2 (range 6 to 100%).

Conclusion. Utilizing a standard protocol for reinforcement, imbrication, and inspection of the staple line in LSG provides excellent rates of postoperative bleeding and leak following sleeve gastrectomy. Further investigation of the unique components of this technique and their contribution to bleeding and leak avoidance is ongoing.

Session: Poster Presentation

Program Number: P628

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