Omar M Ghanem, MD1, Desmond Huynh, MD2, Tomasz Rogula, MD3. 1Mosaic Life Care, 2Cedars Sinai, 3Case Western Reserve University
Introduction: Laparoscopic Sleeve Gastrectomy is the most commonly weight loss procedures performed worldwide. As such, there is great diversity in the techniques utilized. This study aims to identify and categorize the differences in techniques and assess the need for guidelines in this field.
Case Description: Surgeons were surveyed on the techniques they employ on biweekly basis using the International Bariatric Club Facebook group. The survey included sleeve staple line reinforcement, preoperative work up, intraoperative hiatal dissection, bougie size, distance from pylorus to distal staple line, and intraoperative leak testing. Surveys were conducted between May 2017 and July 2017. Each survey was active for 2 weeks after which data was collected. Participants were required to select a single answer per question.
Discussion: When surveyed on staple line reinforcement (n=305), 122 surgeons used no reinforcement, 103 over-sewed, 43 buttressed, 19 clipped as necessary, 10 over-sewed as necessary. For preoperative work up (n=188), 125 utilized routine endoscopy, 9 routinely obtained upper GI series, 2 routinely obtained both endoscopy and upper GI, and 43 employed endoscopy or upper GI series only in patients who were symptomatic. For hiatal dissection (n=168), 14 surgeons dissected the hiatus routinely, 116 dissected only when obvious hernias intraoperatively, 32 dissected only if the hernia was detected on preoperative work up, and 1 dissected in the setting of GERD symptoms. For sleeve caliber sizing (n=275), bougie <32 F was used by 1 surgeon, bougie size 32F, 34F, 36F were utilized by 86, bougie size 38F and 40F were utilized by 171, bougie>40F were used by 4, and gastroscopes (34F) were used by 9. With regards to distance from pylorus to where the sleeve staple line was initiated (n=207), 44 participants started <4cm away from pylorus, 159 between 4 and 6cm, and 4 started >6cm from pylorus. Finally, for preferred intraoperative leak test during sleeve (n=268), methylene blue was used by 133 surgeons, air leak test by 50, 4 used both, and 78 opted for none.
Conclusion: This study characterizes the wide varieties in the techniques used during sleeve gastrectomy. A great number of variations exist in every parameter surveyed; however, there is little evidence comparing the effectiveness and safety of these variations. In this setting, further randomized controlled trials are necessary and should be used to construct guidelines to best optimize outcomes in this extremely common and necessary operation.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86366
Program Number: P543
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
sages_adbutler_leaderboard