Simple versus reinforced cruroplasty in patients submitted to concomitant laparoscopic sleeve gastrectomy: prospective evaluation in a bariatric center of excellence

Ruscio, S.; Abdelgawad, Mohamed; Badiali, Danilo; Iorio, Olga; Rizzello, Mario; Cavallaro, Giuseppe; Severi, Carola; Silecchia, Gianfranço

doi:10.1007/s00464-015-4487-0

Cited by 42 publications

(34 citation statements)

References 28 publications

(34 reference statements)

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“…On the contrary, a recent prospective study, comparing simple and mesh reinforced hiatoplasty in candidates to LSG reported 0 % of leakage in 96 patients [17]. In this study, the GE junction was completely mobilized and exposed with hiatoplasty in all patients and placement of mesh in 48 patients.…”

Section: Ischemic Aspectsmentioning

confidence: 83%

Leaks after laparoscopic sleeve gastrectomy: overview of pathogenesis and risk factors

Iossa

Abdelgawad

Watkins

et al. 2016

Langenbecks Arch Surg

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This review reports factors promoting leak and gives technical recommendations to avoid leak after LSG based on the available evidence and expert consensus which encompasses: (1) use a bougie size ≥40 Fr, EL:1, (2) begin the gastric transection 5-6 cm from the pylorus, EL:2-3, (3) use appropriate cartridge colors from antrum to fundus, EL:1, (4) reinforce the staple line with buttress material, EL:1, (5) follow a proper staple line, (6) remove the crotch staples, EL:4, (7) maintain proper traction on the stomach before firing, (8) stay away from the angle of His at least 1 cm, EL:1, (9) check the bleeding from the staple line, (10) perform an intraoperative methylene blue test, EL:4.

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Section: Ischemic Aspectsmentioning

confidence: 83%

Leaks after laparoscopic sleeve gastrectomy: overview of pathogenesis and risk factors

Iossa

Abdelgawad

Watkins

et al. 2016

Langenbecks Arch Surg

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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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“…With a mean follow-up of 14.6 mo in the LSG with HH repair group and 17.1 mo in the LSG only group, a significant reduction in the prevalence of GERD symptoms was reported only in patients treated with LSG alone, while no improvement was observed among patients undergoing LSG and HH repair. In the absence of recommendations about the use of mesh to close large hiatal hernia defects, Ruscio et al[55] recently reported no mortality and no mesh-related complications in 48 patients undergoing LSG with on-lay synthetic absorbable mesh-reinforced cruroplasty for a large HH (hiatal area defect > 4 and < 8 cm 2 ). With a mean follow-up of 19 mo, GERD symptoms resolved in 95% of patients, while de novo GERD symptoms developed in 3.6% of patients:…”

Section: Proposed Mechanisms Favoring the Occurrence Of Gerd After Lsgmentioning

confidence: 99%

Gastroesophageal reflux disease and morbid obesity: To sleeve or not to sleeve?

Rebecchi

Allaix

Patti

et al. 2017

WJG

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Laparoscopic sleeve gastrectomy (LSG) has reached wide popularity during the last 15 years, due to the limited morbidity and mortality rates, and the very good weight loss results and effects on comorbid conditions. However, there are concerns regarding the effects of LSG on gastroesophageal reflux disease (GERD). The interpretation of the current evidence is challenged by the fact that the LSG technique is not standardized, and most studies investigate the presence of GERD by assessing symptoms and the use of acid reducing medications only. A few studies objectively investigated gastroesophageal function and the reflux profile by esophageal manometry and 24-h pH monitoring, reporting postoperative normalization of esophageal acid exposure in up to 85% of patients with preoperative GERD, and occurrence of de novo GERD in about 5% of cases. There is increasing evidence showing the key role of the surgical technique on the incidence of postoperative GERD. Main technical issues are a relative narrowing of the mid portion of the gastric sleeve, a redundant upper part of the sleeve (both depending on the angle under which the sleeve is stapled), and the presence of a hiatal hernia. Concomitant hiatal hernia repair is recommended. To date, either medical therapy with proton pump inhibitors or conversion of LSG to laparoscopic Roux-en-Y gastric bypass are the available options for the management of GERD after LSG. Recently, new minimally invasive approaches have been proposed in patients with GERD and hypotensive LES: the LINX® Reflux Management System procedure and the Stretta® procedure. Large studies are needed to assess the safety and long-term efficacy of these new approaches. In conclusion, the recent publication of pH monitoring data and the new insights in the association between sleeve morphology and GERD control have led to a wider acceptance of LSG as bariatric procedure also in obese patients with GERD, as recently stated in the 5th International Consensus Conference on sleeve gastrectomy.

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Simple versus reinforced cruroplasty in patients submitted to concomitant laparoscopic sleeve gastrectomy: prospective evaluation in a bariatric center of excellence

Cited by 42 publications

References 28 publications

Leaks after laparoscopic sleeve gastrectomy: overview of pathogenesis and risk factors

Leaks after laparoscopic sleeve gastrectomy: overview of pathogenesis and risk factors

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

Gastroesophageal reflux disease and morbid obesity: To sleeve or not to sleeve?

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