Observed Variability in Sleeve Gastrectomy Volume and Compliance Does Not Correlate to Postoperative Outcomes

Toro, Juan Pablo; Patel, Ankit D.; Lytle, Nathaniel W.; Perez, Sebastian D.; Lee, Edward; Singh, Arvinpal; Davis, Scott

doi:10.1097/sle.0000000000000181

Cited by 17 publications

(12 citation statements)

References 22 publications

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“…After removing duplicates (n = 79), the 1554 records were screened by title and abstract after which 1179 were excluded and the full-text articles for the remaining 375 records were assessed for eligibility. A total of 148 papers were included in the final analysis and the number of studies per reinforcement method were: 69 for NO-SLR [9, 17-84], 70 for suture [9,19,20,22,26,30,46,51,53,75,76,78,83,, 9 for BPS [9,72,78,83,86,89,[141][142][143], 9 for Seal [9,30,61,74,78,103,[144][145][146], and 24 for APM [9,39,52,53,63,89,103,131,[147][148][149][150][151][152][153][154][155][156][157][158][159][160]…”

Section: Study Characteristicsmentioning

confidence: 99%

Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review

Gautier

Kemmeter

2019

Surg Endosc

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Background Staple-line leaks following laparoscopic sleeve gastrectomy (LSG) remain a concerning complication. Stapleline buttressing is largely adopted as an acceptable reinforcement but data regarding leaks have been equivocal. This study compared staple-line leaks in five reinforcement options during LSG: no reinforcement (NO-SLR), oversewing (suture), nonabsorbable bovine pericardial strips (BPS), tissue sealant or fibrin glue (Seal), or absorbable polymer membrane (APM). Methods This systematic review study of articles published between 2012 and 2016 regarding LSG leak rates aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Variables of interest included leak rates, bleeding, and complications in addition to surgical and population parameters. An independent Fisher's exact test was used to compare the number of patients with and without leaks for the different reinforcement options. Results Of the 1633 articles identified, 148 met inclusion criteria and represented 40,653 patients. Differences in age (older in APM; p = 0.001), starting body mass index (lower in Suture; p = 0.008), and distance from pylorus (closer in BPS; p = 0.04) were observed between groups, but mean bougie size was equivalent. The overall leak rate of 1.5% (607 leaks) ranged from 0.7% for APM (significantly lower than all groups; p ≤ 0.007 for next lowest leak rate) to 2.7% (BPS). Conclusions This systematic review of staple-line leaks following LSG demonstrated a significantly lower rate using APM staple-line reinforcement as compared to oversewing, use of sealants, BPS reinforcement, or no reinforcement. Variation in surgical technique may also contribute to leak rates.

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Section: Study Characteristicsmentioning

confidence: 99%

Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review

Gautier

Kemmeter

2019

Surg Endosc

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“…There are different results about the relationship between resected gastric volume and weight loss. In addition, gastric flexibility was examined and no direct associa-tion with excess weight loss (% EWL) was shown (18). Our method seems to be precautioning the surgeon as early as in the theatre that patient who have increased LRL-e will have good EWL at least post-operative 12 mo.…”

Section: Discussion Discussionmentioning

confidence: 99%

Can Gastric Specimen Measurements Defines the Laparoscopic Sleeve Gastrectomy Outcome?

Günal¹,

Uprak²,

Ergenç³

et al. 2018

SGO

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Background: It is a matter of search that resected gastric specimen measurements (RGSM) has an effect on weight loss following LSG. The aim of this study was to investigate the influence of RGSM on weight loss at 3-6-12 months after LSG. Methods: 64 Patients who underwent LSG between 2014-2018 at Marmara University Hospital were enrolled. The LSG procedure and RGSMs were performed using standardized techniques. Patients were followed-up every 3 months in the first year. Correlations between the percentages of excess weight losses (EWL) at 3rd, 6th, 12th months and RGSMs were evaluated. Results: No major complication was seen. Mean body mass index (BMI) at 1 year after LSG was significantly lower than the baseline BMI 50.4±8.4 kg/m 2 versus 31±6.1 kg/m 2 ; P=0.001). Mean % EWLs-3rd,-6th,-12th months were 39%, 59%, 75%, respectively. Resected gastric volume (RGV) was 803.28±37.2 mL. Expansibility on resection line (LRL-e) was 17.2±1.3 %. There was no correlation between RGV and % EWL at 3-6-12 mo. However, the % EWL-12 mo. was correlated with LRL-e (r=0,514, p=0,014). Conclusion: There is a positive correlation between 12th mo EWL% and LRL-e of resected specimen. This may bea harbinger of good weight loss during the theatre.

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“…After the creation of a sleeve, there is increased intraluminal pressure, which incidentally is also thought to play a role in leaks along the staple line [ 14 – 17 ]. Specifically, a study measured the volume and pressure for both the resected stomach and the remaining sleeve and demonstrated the distensibility of the resected portion is 10-fold higher than the gastric sleeve with a significantly lower intraluminal pressure [ 18 , 19 ]. They were able to conclude that the mechanism of restriction following the sleeve gastrectomy is the combination of the small capacity, low distensibility, and the resultant immediate high intraluminal pressure [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Case report of EUS-guided endoscopic transduodenal necrosectomy in a patient with sleeve gastrectomy

et al. 2016

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BackgroundAfter an acute attack of pancreatitis, walled-off pancreatic fluid collections (PFC) occur in approximately 10 % of cases. Drainage of the cavity is recommended when specific indications are met. Endoscopic drainage has been adopted as the main intervention for symptomatic walled-off PFC. Altered gastric anatomy in these patients poses an interesting challenge. We present the first case of a patient with sleeve gastrectomy who underwent successful endoscopic transduodenal necrosectomy (TDN).Case presentationForty year old woman with history of morbid obesity status post sleeve gastrectomy in 2009 was found to have symptomatic gallstone disease complicated by severe necrotizing gallstone pancreatitis and further complicated by symptomatic walled off pancreatic necrosis (WOPN). Imaging significant for 10.8 × 7.6 cm fluid collection with necrotic debris in the body and tail of the pancreas and endoscopic necrosectomy was attempted. EGD showed tubular gastric body and antrum, with extrinsic compression in the antrum and duodenal bulb from the pancreatic cyst. Duodenal bulb was selected as the preferred fistula site due to sleeve gastrectomy. Patient underwent successful TDN in two sessions. Patient had symptomatic improvement at follow-up with resolution of WOPN.ConclusionTo our knowledge, this is the first reported case of EUS-guided endoscopic necrosectomy in a patient with sleeve gastrectomy. The duodenal approach was used in our patient due to history of sleeve gastrectomy.

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Observed Variability in Sleeve Gastrectomy Volume and Compliance Does Not Correlate to Postoperative Outcomes

Abstract: Sleeve gastrectomy specimens exhibit nearly 6-fold variability in both volume and compliance. A large GC is anticipated in male and tall subjects. These observations do not appear to be correlated to %EBWL.

Cited by 17 publications

References 22 publications

Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review

Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review

Can Gastric Specimen Measurements Defines the Laparoscopic Sleeve Gastrectomy Outcome?

Case report of EUS-guided endoscopic transduodenal necrosectomy in a patient with sleeve gastrectomy

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