Measurement of Stomach Wall Thickness to Guide Staple Selection during Sleeve Gastrectomy

Lee, Yoo Jin; Kim, You Na

doi:10.1007/s11695-020-04439-x

Cited by 13 publications

(2 citation statements)

References 13 publications

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“…Rawlins and Rawlins found that the antrum is thicker in male patients with a BMI above 50 kg/m 2 ( 13 ). Lee et al reported a thicker gastric wall in patients whose characteristics included advanced age, male sex, diabetes mellitus, and smoking ( 26 ), but the sample size was small ( n = 30), and average BMI was below 40 kg/m 2 . Correlation of staple-line leakage was not investigated in these studies.…”

Section: Discussionmentioning

confidence: 99%

Primary Sleeve Gastrectomy and Leaks: The Impact of Fundus-Wall Thickness and Staple Heights on Leakage—An Observational Study of 500 Patients

et al. 2021

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Introduction: The most feared complication of laparoscopic sleeve gastrectomy (LSG) is staple-line leakage. Staple height and fundus-wall thickness might influence such leakage, and this study examined their possible impact on leak incidence. Factors including gender, age, comorbidities, and reinforcement of the staple line were also investigated.Methods: A total of 500 patients between 17 and 71 years of age who were scheduled for LSG were selected to participate in the study. For technical reasons, 53 were excluded. The fundus-wall thickness of 447 patients after LSG was investigated. The impact of staple height, fundus-wall thickness, demographic and medical factors on leak incidence were investigated. Most of our patients (309) were female (69%), while 138 were male (31%).Results: The mean thickness of the proximal fundus wall was 2,904 μm, 3,172 μm in men and 2,784 μm in women. The leak rate was 4.9%. Age, fundus-wall thickness, and BMI showed a strong influence on leak risk, but this effect was significant only for age (p = 0.01). Patient gender and staple size showed no significant influence on the correlation between fundus-wall thickness and leak risk. Gender displayed a small effect of influence on this correlation, with η2 = 0.05.Discussion: Because older age had a significant effect on increasing the risk of staple-line leakage, there is a need for a more specific focus on these patients. Thinner fundus wall and female gender might predispose patients to staple-line leaks, but a significant value could not be reached. Therefore, staple size should remain the surgeon's choice based on clinical experience.

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Section: Discussionmentioning

confidence: 99%

Primary Sleeve Gastrectomy and Leaks: The Impact of Fundus-Wall Thickness and Staple Heights on Leakage—An Observational Study of 500 Patients

et al. 2021

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“…Interestingly, wireless control of implanted LED devices has already been successfully applied within the colon of transgenic mice to increase the fecal pellet output [28] and recently in the bladder to trigger urination [69]. The SMC layer on the outer surface of the human stomach is only approximately 2 mm thick [70,71]. This is important since it allows the use of blue light for efficient illumination of the whole muscular layer with reasonable light intensities and thus also more restricted light effects assuming similar light absorption of the SMC tissue compared to the heart [72].…”

Section: Discussionmentioning

confidence: 99%

Direct optogenetic stimulation of smooth muscle cells to control gastric contractility

Patejdl

Vogt²,

Schulz

et al. 2021

Viszeralmedizin 2021 Gemeinsame Jahrestagung Deutsche Gesellschaft Für Gastroenterologie, Verdauungs- Und Stoffwechselkrankheit

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Rationale: Antral peristalsis is responsible for gastric emptying. Its failure is called gastroparesis and often caused by dysfunction of enteric neurons and interstitial cells of Cajal (ICC). Current treatment options, including gastric electrical stimulation, are non-satisfying and may improve symptoms but commonly fail to restore gastric emptying. Herein, we explore direct optogenetic stimulation of smooth muscle cells (SMC) via the light-gated non-selective cation channel Channelrhodopsin2 (ChR2) to control gastric motor function. Methods: We used a transgenic mouse model expressing ChR2 in fusion with eYFP under the control of the chicken-β-actin promoter. We performed patch clamp experiments to quantify light-induced currents in isolated SMC, Ca 2+ imaging and isometric force measurements of antral smooth muscle strips as well as pressure recordings of intact stomachs to evaluate contractile responses. Light-induced propulsion of gastric contents from the isolated stomach preparation was quantified in video recordings. We furthermore tested optogenetic stimulation in a gastroparesis model induced by neuronal-and ICC-specific damage through methylene blue photo-toxicity. Results: In the stomachs, eYFP signals were restricted to SMC in which blue light (460 nm) induced inward currents typical for ChR2. These depolarizing currents led to contractions in antral smooth muscle strips that were stronger than those triggered by supramaximal electrical field stimulation and comparable to those evoked by global depolarization with high K + concentration. In the intact stomach, panoramic illumination efficiently increased intragastric pressure achieving 239±46% (n=6) of the pressure induced by electrical field stimulation and triggered gastric transport. Within the gastroparesis model, electric field stimulation completely failed but light still efficiently generated pressure waves. Conclusions: We demonstrate direct optogenetic stimulation of SMC to control gastric contractility. This completely new approach could allow for the restoration of motility in gastroparesis in the future.

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Gastric Wall Thickness and Linear Staple Height in Sleeve Gastrectomy in Japanese Patients with Obesity

et al. 2021

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Measurement of Stomach Wall Thickness to Guide Staple Selection during Sleeve Gastrectomy

Cited by 13 publications

References 13 publications

Primary Sleeve Gastrectomy and Leaks: The Impact of Fundus-Wall Thickness and Staple Heights on Leakage—An Observational Study of 500 Patients

Primary Sleeve Gastrectomy and Leaks: The Impact of Fundus-Wall Thickness and Staple Heights on Leakage—An Observational Study of 500 Patients

Direct optogenetic stimulation of smooth muscle cells to control gastric contractility

Gastric Wall Thickness and Linear Staple Height in Sleeve Gastrectomy in Japanese Patients with Obesity

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