Results of More Than 11,800 Sleeve Gastrectomies

Stroh, Christine; Köckerling, F.; Lange, Volker; Benedix, Frank; Wolff, S.; Knoll, C.; Christiane, Bruns; Mussack, Thomas

doi:10.1097/sla.0000000000001559

Cited by 89 publications

(27 citation statements)

References 18 publications

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“…The lack of adherence to follow-up was reported previously, and it can be related to several issues, including the distance to the medical office and a lack of trust or rapport with the surgeon or the medical team[46]. However, the most relevant strength of this study is that all patients underwent a standardized LSG operative technique, first, because surgeon expertise is a key issue to lower the complications rate[13,24] and second, because there were no technical differences that may influence the weight loss results. We always tried to perform a more restrictive LSG by using a thinner bougie and beginning the dissection 3 cm from the pylorus to achieve greater weight loss, as suggested by Baltasar et al[8,31].…”

Section: Discussionmentioning

confidence: 92%

“…The method for doing so is still a matter of debate[21]. Some reports showed no differences between oversewing of the staple line and the use of buttresses[22-24]. However, a systematic review of 88 included studies representing 8920 patients[15] found that the leak rate in LSG was significantly lower using absorbable membrane (Seamguard ® ) staple-line reinforcement (1.1%) than was oversewing (2.0%), bovine pericardial strip (BPS-Peristrips ® ) reinforcement (3.3%), or no reinforcement (2.6%).…”

Section: Discussionmentioning

confidence: 99%

“…No leaks were observed in the Seamguard ® subgroup but the small number of patients in this series does not allow further analysis. It must be noted that the significantly highest incidence of leaks was reported when using both sutures and buttressing material (3.6%); consequently, this approach should always be avoided[24]. …”

Section: Discussionmentioning

confidence: 99%

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Five-year outcomes of laparoscopic sleeve gastrectomy as a primary procedure for morbid obesity: A prospective study

Hoyuela¹

2017

WJGS

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AIMTo prospectively evaluate the postoperative morbi-mortality and weight loss evolution of patients who underwent a laparoscopic sleeve gastrectomy (LSG) as a primary bariatric procedure during 5 years of follow-up.METHODSSince 2006, data from patients undergoing a highly restrictive primary LSG have been prospectively registered in a database and analysed. Preoperative co-morbid conditions, operating time, hospital stay, early and late complications rate and evolution of weight loss after 5 years of follow-up were analysed.RESULTSA total of 156 patients were included, 74.3% of whom were women. The mean age was 43.2 ± 13.1 years and the mean body mass index (BMI) was 41.5 ± 7.9 kg/m2. Seventy patients (44.8%) presented a BMI under 40 kg/m2. The mortality rate was 0%. The leakage rate was 1.2%, and the total 30-d morbidity rate was 5.1% (8/156). With a mean follow-up of 32.7 ± 28.5 (range 6-112) mo, the mean percent of excess of weight loss (%EWL) was 82.0 ± 18.8 at 1 year, 76.7 ± 21.3 at 3 years and 60.3 ± 28.9 at 5 years. The mean percent of excess of BMI loss (%EBMIL) was 94.9 ± 22.4 at 1 year, 89.4 ± 27.4 at 3 years and 74.8 ± 29.4 at 5 years. Patients with preoperative BMI less than 40 kg/m2 achieved greater weight loss than did the overall study population. Diabetes remitted in 75% of the patients and HTA improved in 71.7%. CPAP masks were withdrawn in all patients with obstructive sleep apnoea.CONCLUSIONLSG built with a narrow 34 F bougie and starting 3 cm from the pylorus proved to be safe and highly effective in terms of weight loss as a stand-alone procedure, particularly in patients with a preoperative BMI lower than 40 kg/m2.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Five-year outcomes of laparoscopic sleeve gastrectomy as a primary procedure for morbid obesity: A prospective study

Hoyuela¹

2017

WJGS

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“…This is further corroborated by Parikh et al [14] who concluded that performance of the leak test did not seem to impact the leak rate (P = 0.454). Some studies have even suggested that intra operative leakage testing was a risk factor for leakage with an odds ratio of 2.26 [16] .…”

Section: Discussionmentioning

confidence: 99%

The Birmingham experience of high-pressure methylene blue dye test during primary and revisional bariatric surgery: A retrospective cohort study

Kirby

Macano

Nyasavajjala

et al. 2017

Annals of Medicine &Amp; Surgery

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IntroductionLeak following bariatric surgery continues to be associated with morbidity and rarely mortality. With improvement in surgical techniques and stapler design, leak rates have reduced drastically. Intra-operative high pressure Methylene blue leak test (HPMB) is one of the techniques employed to confirm integrity of anastomoses and staple lines. Despite this, evidence for its use remains limited. We evaluated the role of HPMB in detecting and preventing leaks.MethodsA retrospective cohort of consecutive patients who underwent primary or revisional Laparoscopic Sleeve Gastrectomy (SG) or Laparoscopic Roux-en-Y Gastric bypass (RYGB) under the care of five surgeons in three centres across Birmingham, UK, between 2012 and 2016 were assessed. All patients had routine HPMB at the end of the procedure. Demographics, HPMB positivity, and post operative leaks were recorded.Results924 patients underwent bariatric surgery: 696(75.3%) RYGB, and 225(24.3%) SG. 85(9.2%) were revisional procedures.Two HPMB were positive, which necessitated staple or suture line reinforcement with sutures intra-operatively. The patients had an uneventful recovery. 5 patients had postoperative leaks, all of whom had negative intraoperative HPMB: 3 SG patients; and 2 RYGB patients (gastro-jejunostomy anastomotic leaks). There was no statistically significant relationship between positive HPMB and anastomotic leak (Fishers exact test; p = 1).ConclusionDespite routine use of methylene blue dye test in 924 patients, there were only two positive tests. Whilst HPMB may demonstrate technical failure, this study suggests that there is no role for its routine use in primary bariatric surgery. Discontinuation of this practice would reduce risk of anaphylaxis to the dye, cost, and intra-operative time.

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“…Laparoscopic sleeve gastrectomy is at risk of resection line leaks in 1.1% to 6.5% of cases according to world literature [2–4]. In terms of pathogenesis, the leak is caused by a combination of: a) local factors – partial stomach wall ischemia, amount of stomach tissue caught in the staple, size of the staples, and staple failure, and b) general factors – metabolic disorders, abdominal obesity, etc.…”

Section: Discussionmentioning

confidence: 99%

Staple line leak with peritonitis after laparoscopic sleeve gastrectomy - a solution in one to six steps.

Špička¹

2017

Videosurgery and Other Miniinvasive Techniques

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IntroductionLaparoscopic sleeve gastrectomy (LSG) is one of the most efficient bariatric interventions in morbidly obese patients. The most severe risk of this procedure seems to be the staple line leak, and the management of this complication can be very arduous.AimTo share our experience in managing the staple line leak after LSG and to help to find the best procedure that should be preferred.Material and methodsIn the 2010–2015 period we performed 223 LSG, with about 5 demonstrating severe complications – two patients with severe bleeding requiring revision surgery, and three patients with resection surface leak.ResultsWe always primarily treated the staple line leak with a laparoscopic revision. Once the fistula did not spontaneously close after this treatment. A series of other methods were then indicated for this patient and only the sixth one resulted in the desirable therapeutic success. At first, our team opted for laparoscopic revision with drainage. The next procedure involved applying Ovesco and Boston clips. As a third method we performed abscess drainage through a nasobiliary tube inserted via gastroscopy. Due to failure we performed the second laparoscopic revision with staple line resuture, the next intervention was an open revision with fistula excision and suture, and finally we opted for the application of a self-expanding metallic stent, which proved to be definitely curative.ConclusionsWithout any guidelines it is very difficult to determine the right procedure addressing the staple line leak after LSG. It depends mainly on the clinician’s experience and is lengthy and often untraditional.

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Results of More Than 11,800 Sleeve Gastrectomies

Cited by 89 publications

References 18 publications

Five-year outcomes of laparoscopic sleeve gastrectomy as a primary procedure for morbid obesity: A prospective study

Five-year outcomes of laparoscopic sleeve gastrectomy as a primary procedure for morbid obesity: A prospective study

The Birmingham experience of high-pressure methylene blue dye test during primary and revisional bariatric surgery: A retrospective cohort study

Staple line leak with peritonitis after laparoscopic sleeve gastrectomy - a solution in one to six steps.

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