Perioperative Practices Concerning Sleeve Gastrectomy – a Survey of 863 Surgeons with a Cumulative Experience of 520,230 Procedures

Abstract

Background Sleeve Gastrectomy (SG) is the most commonly performed bariatric procedure worldwide. There is currently no scientific study aimed at understanding variations in practices concerning this procedure. The aim of this study was to study the global variations in perioperative practices concerning SG. Methods A 37-item questionnaire-based survey was conducted to capture the perioperative practices of the global community of bariatric surgeons. Data were analysed using descriptive statistics. Results Response of 863 bariatric surgeons from 67 countries with a cumulative experience of 520,230 SGs were recorded. A total of 689 (80%) and 764 (89%) surgeons listed 13 absolute and relative contraindications, respectively. 65% (n = 559) surgeons perform routine preoperative endoscopy and 97% (n=835) routinely use intraoperative orogastric tube for sizing the resection. A wide variation is observed in the diameter of the tube used. 73% (n=627) surgeons start dividing the stomach at a distance of 3-5 cm from the pylorus, and 54% (n=467) routinely use staple line reinforcement. Majority (65%, n=565) of surgeons perform routine intraoperative leak test at the end of the procedure, while 25% (n=218) surgeons perform a routine contrast study in the early postoperative period. Lifelong 2 multivitamin/mineral, iron, vitamin D, calcium, and vitamin B12 supplementation is advocated by 66%, 29%, 40%, 38% and 44% surgeons, respectively. Conclusion There is a considerable variation in the perioperative practices concerning SG. Data can help in identifying areas for future consensus building and more focussed studies.

A Comprehensive Review of Endoscopic Management of Sleeve Gastrectomy Leaks

“…Intraoperative leak tests can identify otherwise undetectable areas of staple line disruption that prompts immediate treatment and closure to prevent further development and complications of leak 47,71,125,145–147. Nevertheless, their routine use is still debated 48,56,148–152. Most common intraoperative leak tests include: intraoperative endoscopy, air leak testing, and transgastric dye injection.…”

“…47,71,125,[145][146][147] Nevertheless, their routine use is still debated. 48,56,[148][149][150][151][152] Most common intraoperative leak tests include: intraoperative endoscopy, air leak testing, and transgastric dye injection. Use of 100 to 150 cm 3 of air to insufflate the stomach through a nasogastric tube or endoscope can be used to detect air bubbles indicating leakage.…”

Cost-effectiveness of Staple Line Reinforcement in Laparoscopic Sleeve Gastrectomy

“…9 These overall favorable outcomes mirror the growing adoption of SLR, with recent studies reporting that 43% to 54% of surgeons internationally and 80% DOI: 10.1097/SLA.0000000000004950 of surgeons within the United States use SLR in sleeve gastrectomy. 7,10,11 Despite the extensive degree to which previous studies have assessed the clinical outcomes associated with SLR use, cost analyses are lacking. 12 Previous single-center studies from European hospital systems have quantified costs associated with bleed and leak complications 13,14 and suggested cost savings for use of SLR for high-risk patient groups, 15 but to our knowledge, no formal cost-effectiveness analyses have been performed.…”

“…9 These overall favorable outcomes mirror the growing adoption of SLR, with recent studies reporting that 43% to 54% of surgeons internationally and 80% of surgeons within the United States use SLR in sleeve gastrectomy. 7,10,11…”

Will Gastroenterologists Be Successful as Metabolic Physicians?

“…Individuals with diabetes mellitus considered in diabetes guidelines [5] as candidates for bariatric surgery have: a body mass index 30-34.9 kg/m 2 with inadequate control of hyperglycemia during the use of oral or injectable medications (an indication that is not consistent with present National Institutes of Health guidelines for bariatric surgery), a body mass index 35-39.9 kg/m 2 with inadequate control of hyperglycemia during optimal medical therapy, or a body mass index ≥ 40 kg/m 2 . Bariatric surgeons favor Roux Y gastric bypass for those diabetic individuals with significant chronic gastroesophageal reflux or with insulin-dependent type 2 diabetes mellitus [6] . Their concern in those individuals with chronic gastroesophageal reflux is based upon VSG being a refluxogenic procedure.…”