Impact of surgeon experience and buttress material on postoperative complications after laparoscopic sleeve gastrectomy

Daskalakis, Markos; Berdan, Yakup; Theodoridou, Sophia; Weigand, Gerhard; Weiner, Rudolf A.

doi:10.1007/s00464-010-1136-5

Cited by 77 publications

(30 citation statements)

References 39 publications

(42 reference statements)

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“…In a study by Daskalakis et al. [13], early complication rate was 10% and the use of buttress material was associated with improved perioperative outcome, not the surgeons' experience. In our study, the major surgical morbidity was 9% for the younger patients and 42% for the older patients.…”

Section: Discussionmentioning

confidence: 94%

“…It is suitable for revisions for failed gastric banding or gastroplasty [23][24][25], but prone to more complications compared to an initial laparoscopic sleeve gastrectomy (LSG) without a prior bariatric procedure [26]. The mortality rate for sleeve gastrectomy has been 0-3.2% [8][9][10][11], and the complication rate has described to be 4.8-10% including mainly leaks and hemorrhages [9][10][11][12][13]. In a study by Daskalakis et al.…”

Section: Discussionmentioning

confidence: 99%

“…In a study by Lakdawala et al [7], sleeve gastrectomy (SG) was as safe as gastric bypass with no mortality, but more comparative studies are needed. The mortality rate for sleeve gastrectomy has been 0-3.2% [8][9][10][11], and the complication rate has described to be 4.8-10%, including mainly leaks and hemorrhages [9][10][11][12][13]. Sleeve gastrectomy has shown to be more effective than gastric banding with less adverse symptoms [14].…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic Sleeve Gastrectomy in Patients over 59 Years: Early Recovery and 12-Month Follow-Up

et al. 2011

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Background Bariatric surgery has shown to be safe for patients over 60 years with good results especially considering resolving of comorbidities. Sleeve gastrectomy is considered to be safer than gastric bypass (GBP) and more effective than gastric banding with less adverse symptoms. Weight loss may be more modest than after GBP, but the effect on vitamins may also be milder. Methods Since 2007, we collected prospectively 12-month follow-up data from 55 sleeve gastrectomy patients of whom 12 were over 59 years of age. Vitamin and calcium supplements were used postoperatively. The recovery from the operation was recorded during hospital stay, at 1-and 12-month follow-up visits using a standard protocol including laboratory tests. The results between patients over and under 59 years were compared. Results The preoperative weight and weight loss were comparable between the groups. Operation time was shorter and hospital stay was longer for older patients, p= ns. There was no operative mortality. Early major complications were seen more often in the older age group, 42% vs 9% (p=0.02), but late complications were more common in younger patients, 17% vs 44%, p=ns. Early complications were mostly bleedings, which did not lengthen the hospital stay, neither were re-operations nor endoscopic procedures needed. Excess weight loss and resolving of comorbidities after 12 months was comparable between the groups. However, vitamin deficiencies and hypoalbuminemia were more common in the older age group, 42% and 23% for vitamins and 44% and 29% for proteins, p =ns. The older patients had more adverse effects related to surgery, 25% vs 9%, and younger had more adverse psychiatric effects, p=ns. Conclusions Sleeve gastrectomy is effective and safe for older bariatric patients. Weight loss is comparable to younger patients and enough to resolve the comorbidities in most of the patients. With standardized nutritional supplementation, the older patients had more often vitamin deficiencies and hypoalbuminemia. Although operative treatment of older bariatric patients is safe, their postoperative care is demanding considering vitamins and protein.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Laparoscopic Sleeve Gastrectomy in Patients over 59 Years: Early Recovery and 12-Month Follow-Up

et al. 2011

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“…Suture line reinforcement allows a significant reduction in bleeding but has no significant influence on the leakage rate. These finding are not new [1,2], and leakage is still the Achilles heel of the procedure compared to gastric bypass surgery. Weight loss and comorbidities during the first 2 years are comparable to proximal gastric bypass, as is the problem of weight regain.…”

Section: Discussionmentioning

confidence: 99%

Failure of Laparoscopic Sleeve Gastrectomy – Further Procedure?

2011

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Background: Worldwide, the incidence of morbid obesity is increasing, and surgery is the only effective longterm treatment. Laparoscopic sleeve gastrectomy (LSG) is associated with acceptable weight loss and reduced comorbidities. It is considered a safe procedure with sporadic complications. This publication aims to describe failures of LSG in terms of ineffective weight loss or early weight regain, and analyze secondary treatment options. Methods: From October 2001 to December 2010, 937 patients underwent LSG in our department. Initially, all procedures were scheduled as a two-stage procedure (LSG followed by biliopancreatic diversion with duodenal switch). However, the second procedure was not performed in 64 patients (body mass index > 60 kg/m²). Since 2005, the frequency of second stage procedures after weight regain has been increasing; their outcome is analyzed. Results: Of the 937 patients, 17 (1.8%) experienced staple line leakage. Mean time to first reintervention or endoscopic stent placement was 15.6 ± 22 days (range 2–78). From 2005 to 2010, 106 secondary procedures were performed. Insufficient weight loss or weight regain were the indications in 88 cases. Sixteen (15%) patients had severe gastroesophageal reflux which was resolved by Roux-en-Y gastric bypass (RYGB). Stenosis was observed in 2 (2.6%) patients, which required endoscopic dilatation and stent placement in one case and gastric bypass in the other. Conclusions: LSG is a feasible and popular bariatric procedure. Mortality (0.4%) was much higher than after gastric bypass (0.03%) and gastric banding (0%) The knowledge of potential complications and their management is crucial. All restrictive procedures require patient compliance, but increased food uptake after RYGB and LSG is common. Malabsorptive procedures are more effective for long-term weight loss. Duodenal switch and omega-loop gastric bypass are more efficient second stage procedures than re-sleeve or RYGB.

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“…3 Buttressing material is becoming widely used as a means of lowering intraoperative as well as postoperative complications 4,5 ; moreover, it is associated with lower complication in early surgeon experience. 6 A number of staple-line buttressing reinforcements described in the literature include bioabsorbable polyglycolic acid and trimethylene carbonate (Gore Seamguard ® ), nonabsorbable bovine pericardium (Peri-Strips Dry ® ) and small bowel submucosa (Surgisis ® ).…”

Section: Discussionmentioning

confidence: 99%