The effect of calibration device choice on sleeve gastrectomy pouch creation and subsequent weight loss

Christopher Guidry, MD, Obos Ekhaese, DO. University of Texas Medical Branch

Background: Controversy exists amongst expert sleeve gastrectomy surgeons on the ideal technique for the creation of gastric pouch. There are many technical variations on the creation of a gastric sleeve including the type of calibration device used, use of varying sizes of bougie dilators, or employing a gastroscope as a bougie.  This study investigates compares two technical variations to the gastric sleeve creation (bougie dilator vs. gastroscope as bougie) to determine if an appreciable difference in excess body weight loss occurs.                 

Methods: We performed a retrospective chart review of the first 100 patients who underwent a laparoscopic or robotic sleeve gastrectomy from March 2010 to August 2014.  The techniques used for the creation of the gastric sleeve were examined.  Teleflex Maloney esophageal dilator bougie that ranged in size from 36F to 42F and video gastroscope with an 11mm diameter/33F were the calibration devices used in all but 2 of the cases, in which the Visigi-3D 40F calibration device was utilized.  Each patient’s pre-operative weight, BMI, ideal body weight (IBW) and excess body weight (EBW) were examined prior to operation.  Each patient’s excess weight loss percentage (EWL%) were recorded during follow-up clinic visits at 1 month, 3 month, 6 month, 1 year intervals.

Results: The Maloney bougie dilator was used in 73 patients and the gastroscope + Visigi as a bougie / calibration was used in 27 patients.  The average pre-operative BMI for the Maloney dilator and gastroscope groups were 42.6kg/m2 and 41.4kg/m2, respectively.  Average EWL% with the Maloney dilator was 19%, 30%, 36% and 38% at 1 month, 3 months, 6 months and 1 year respectively.  Average EWL% with the gastroscope as a bougie was 19.1%, 33.6%, 44% and 59% at 1 month, 3 months, 6 months and 1 year respectively.               

Conclusions: There is an appreciable difference in weight loss in patients whom had gastric sleeves created via the gastroscope as a bougie at 6 months and 1-year intervals compared to the utilization of an esophageal dilator as a bougie.  These findings may have been due to the suction component of the gastroscope, as well as the uniform diameter and its blunt end versus a tapered Maloney bougie dilator, which allows for a more precise sleeve creation by improving visualization and contour of the gastric sleeve.  Future studies will focus on increasing the number of endoscopic bougie cases and follow both patient groups at 2 year and 3 year intervals.

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