Impact of Resection Volume/Stapler Firings-Ratio on Perioperative Complications and Weight Loss After Laparoscopic Sleeve Gastrectomy

Abstract

Background Major postoperative morbidity after laparoscopic sleeve gastrectomy (LSG) is often related to staple line leaks (SLL). Of note, a recent study suggested a central role of the absolute numbers of stapler firings as a predictive factor for postoperative morbidity due to SLL. In addition, a larger gastric remnant volume could be responsible for lower weight loss after LSG, and nevertheless, the gastric resection volume (GRV) is strictly related to the residual volume. Methods Prospectively, collected data of 384 consecutive patients with complete follow-up at 12 months after LSG at our institution were retrospectively analyzed. Patients were stratified according to three different variables (i.e., number of stapler firings, GRV, and GRV/stapler firings-ratio), and respective impact on postoperative complications and weight loss was analyzed. Results High absolute number of stapler firings was linked to increased intraoperative and postoperative bleeding and prolonged hospitalization, but was not associated with SLL, transfusion rate or revisional procedures. Absolute GRV showed no impact on both complications and outcome after LSG. Interestingly, higher ratio of GRV/stapler firings was not only linked to decreased intraoperative bleeding and shorter hospital stay but also to higher Excess Body Mass Index Loss (EBMIL) at 12 months after LSG. Conclusions Here, we introduce GRV/stapler firings-ratio as a simple predictive factor for identifying patients at risk for postoperative complications and impaired weight loss that is superior compared with absolute number of stapler firings or GRV alone.

Effect of Spleen Size on Complications of Laparoscopic Sleeve Gastrectomy

“…The median number of stapler cartridges used during LSG procedure was 4 (ranging between 3 -8), and in multivariate logistic regression analysis, the absolute number of stapler firings was significantly related to a higher rate of postoperative complication (19). Penna et al (2021) published that high absolute number of stapler firings was linked to increased intraoperative blood loss, postoperative bleeding, and prolonged hospital stay. Their data provided further evidence that the higher number of stapler firings during LSG is an indicator of surgical technique reflecting intraoperative difficulties, increased operation time and finally resulting in a higher rate of post-operative complications, although there was no association with the incidence of staple line leaks (20).…”

“…Penna et al (2021) published that high absolute number of stapler firings was linked to increased intraoperative blood loss, postoperative bleeding, and prolonged hospital stay. Their data provided further evidence that the higher number of stapler firings during LSG is an indicator of surgical technique reflecting intraoperative difficulties, increased operation time and finally resulting in a higher rate of post-operative complications, although there was no association with the incidence of staple line leaks (20). Up to date the association of multiple stapler firings and higher risk of anastomotic leakage has already been described in colorectal surgery but not in LSG (21).…”

Vasoconstrictor nasal spray causing life-threatening complications after bariatric surgery: A case report

“…However, a study published in 2019 including >250,000 patients with significantly lower postoperative complication rates in LSG than in LRYGB was found [5] . Complications include bleeding, hemorrhage, staple line leaks, strictures, bile reflux, intussusception, and ulcer or perforation at the anastomosis [5] , [6] , [7] , [8] , [9] .…”

Can Weight of The Resected Stomach Predict Weight Loss Results After Laparoscopic Sleeve Gastrectomy?

“…[11][12][13][14][15][16][17] Among the technical factors predicting the success of the LSG in terms of weight loss, the use and size of a bougie to calibrate the sleeve, resection distance from the pylorus, resected gastric volume (RGV), and sleeve size were the ones scrutinized extensively. 15,16,[18][19][20][21][22][23] Many studies have focused on the RGV during the LSG procedure as a potential predictor of weight loss outcomes. [24][25][26][27] However, these studies had inconsistent results, some showing a significant relationship between RGV and weight loss 25,28 while others did not.…”

“…In some of these studies, the patient’s demographic characteristics, preoperative obesity-related comorbidities, body mass index (BMI), and psychosocial status were examined, while in others, the technical aspects of the surgery 11–17 . Among the technical factors predicting the success of the LSG in terms of weight loss, the use and size of a bougie to calibrate the sleeve, resection distance from the pylorus, resected gastric volume (RGV), and sleeve size were the ones scrutinized extensively 15,16,18–23 …”