Vanessa Boudreau, MD, Scott Gmora, MD, Dennis Hong, MD, Mehran Anvari, MD, PhD, Karen Barlow, Hons, BSc, Olivia Lovrics, MSc. Center for Minimal Access Surgery, McMaster University, Ontario, Canada
Introduction: No consensus exists in the literature for the best surgical technique when performing a sleeve gastrectomy. Medial and lateral approaches have been described, but no study could identify if one technique is better in terms of clinical outcomes. This study aims to compare the medial and lateral approach for sleeve gastrectomy (SG) in terms of intraoperative and postoperative complications, and weight loss, and to determine if both techniques are equivalent.
Methods: Data from the Ontario Bariatric Registry was used for this retrospective study to compare the effectiveness and safety of sleeve gastrectomy using the medial approach versus the lateral approach, during a 3-year follow-up after SG.
Results: Between January 2010 and June 2015, 564 patients underwent a sleeve gastrectomy surgery at St Joseph’s Healthcare Hamilton. 229 patients underwent a medial approach (72.9% female, age 46.9, BMI 54.4) and 335 underwent a lateral approach (73.1% female, age 48.8, BMI 56.3). Both groups were comparable in terms of baseline comorbidities. Weight loss and rate of complications at 3-year follow-up are as follows:
| Medial approach | Lateral approach | p-value | |
| Weight loss | |||
|
Decrease in BMI (SD) 1 year 3 years |
15.9 (7.0) 14.5 (6.7) |
15.0 (7.6) 13.7 (8.3) |
NS NS |
| OR time minutes (SD) | 70.4 (15.8) | 95.3 (31.3) | <0.05 |
| Complications n (%) | |||
| Mortality 30 days | 0 | 0 | NS |
| Overall complications | 10 (4.4) | 11 (3.3) | NS |
| Wound infection | 1 (0.4) | 2 (0.6) | NS |
| Stenosis and stricture | 2 (0.9) | 1 (0.3) | NS |
| Hospitalization | 4 (1.7) | 6 (1.8) | NS |
| Revisional surgery | 3 (1.3) | 4 (1.2) | NS |
Conclusions: Both the lateral and the medial approach are effective and safe for performing the sleeve gastrectomy. No significant differences were seen in weight loss and rate of complications at 3 years. The medial approach may decrease operative time. Further study is needed to evaluate this finding.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94711
Program Number: P194
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster