Does Fixation of Gastric Sleeve Prevent Functional Stenosis in Sleeve Gastrectomy Patients?

Abstract

The aim of this study is to determine whether gastric sleeve fixation prevents functional stenosis (twist or kink) and to investigate its effects on symptoms such as nausea and vomiting after laparoscopic sleeve gastrectomy (LSG).Methods: A total of 717 patients who underwent primary LSG for morbid obesity and completed at least 1 year of follow-up between 2012 and 2019 were included in the study. All operations were performed by the same surgical team using the same technique. The patients were divided into 2 groups, that is, group 1: standard LSG and group 2: gastric sleeve fixation with LSG. These 2 groups were compared in terms of demographic characteristics, baseline body mass index, follow-up duration, bleeding, leaks, gastric stenosis, postoperative nausea, vomiting, and the need for antiemetics. In the follow-up period, patients with suspected gastric stenosis underwent endoscopy and upper gastrointestinal series.Results: LSG was performed in 717 patients (55.2% female) with a mean age of 37.8 ± 11.5 years and a median body mass index of 42.2 (30.2 to 74.2) kg/m 2 . The 241 patients in the first group underwent LSG without fixation, and the 476 patients in the second group with fixation. Functional stenosis was detected in 8 patients, all of whom were in group 1. One patient in group 1 had a leak on the background of functional stenosis. There was bleeding that required transfusion in 2 patients (group 1) and reoperation in 2 patients (group 2). None of the study patients died. During the in-hospital period, 122 (50.6%) patients in group 1 and 159 (33.4%) patients in group 2 had nausea and vomiting that required antiemetic treatment (P < 0.001). Conclusion:Gastric sleeve fixation in LSG prevents complications that may arise because of improper gastric mobilization. This method is effective in reducing nausea and vomiting in LSG patients.

Review of Our Experience Using Modified Staple Line Suturing Technique in Laparoscopic Sleeve Gastrectomy

“…Since then, we started performing gastric sleeve fixation routinely in all patients. We did not detect any stenosis in our series after we started performing sleeve fixation 7…”

“…We did not detect any stenosis in our series after we started performing sleeve fixation. 7 Most of the leaks in LSG are seen at the top of the stapler line in the angle of his region. In this region, it is extremely important to choose the right cartridge and not to get too close to the gastroesophageal junction.…”

“…Some studies have reported an increased bleeding rate with suturing. 7,15 This may be related to the level of experience with suturing technique. The bleeding rate of 0.4% in our study is still low compared with the rates in most of the studies.…”

“…Our preoperative-postoperative protocol and surgical technique are shown before 7,8. All operations were done by the same team and the same technique.…”

“…Our preoperative-postoperative protocol and surgical technique are shown before. 7,8 All operations were done by the same team and the same technique. The 12 mm optic trocar (Endopeth Xcel) was entered into the abdomen under direct vision from the left subcostal area.…”