The Impact of Different Surgical Techniques on Outcomes in Laparoscopic Sleeve Gastrectomies

Berger, Elizabeth R.; Clements, Ronald H.; Morton, John M.; Huffman, Kristopher M.; Wolfe, Bruce M.; Nguyen, Ninh T.; Ko, Clifford Y.; Hutter, Matthew M.

doi:10.1097/sla.0000000000001851

Cited by 185 publications

(57 citation statements)

References 45 publications

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“…All bariatric and metabolic operations (eg, adjustable gastric band, Roux-en-Y gastric bypass, sleeve gastrectomy) and procedures for complications directly related to these operations performed at accredited hospitals (see supplemental file for more details) are accrued. 16 17 18 19 21 22 Supplemental table 1 depicts the characteristics of MBSAQIP accredited hospitals compared with non-MBSAQIP accredited hospitals.…”

Section: Methodsmentioning

confidence: 99%

Concurrent bariatric operations and association with perioperative outcomes: registry based cohort study

Liu

Ban

Berian

et al. 2017

BMJ

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Objective To determine whether perioperative outcomes differ between patients undergoing concurrent compared with non-concurrent bariatric operations in the USA. Design Retrospective, propensity score matched cohort study. Setting Hospitals in the US accredited by the American College of Surgeons’ metabolic and bariatric surgery accreditation and quality improvement program. Participants 513 167 patients undergoing bariatric operations between 1 January 2014 and 31 December 2016. Main outcome measures The primary outcome measure was a composite of 30 day death, morbidity, readmission, reoperation, anastomotic or staple line leak, and bleeding events. Operative duration and lengths of stay were also assessed. Operations were defined as concurrent if they overlapped by 60 or more minutes or in their entirety. Results In this study of 513 167 operations, 739 (29.5%) surgeons at 483 (57.8%) hospitals performed 6087 (1.2%) concurrent operations. The most frequently performed concurrent bariatric operations were sleeve gastrectomy (n=3250, 53.4%) and Roux-en-Y gastric bypass (n=1601, 26.3%). Concurrent operations were more often performed at large academic medical centers with higher operative volumes and numbers of trainees and by higher volume surgeons. Compared with non-concurrent operations, concurrent operations lasted a median of 34 minutes longer (P<0.001) and resulted in 0.3 days longer average length of stay (P<0.001). Perioperative adverse events were not observed to more likely occur in concurrent compared with non-concurrent operations (7.5% v 7.4%; relative risk 1.02, 95% confidence interval 0.90 to 1.15; P=0.84). Conclusions Concurrent bariatric operations occurred infrequently, but when they did, there was no observable increased risk for adverse perioperative outcomes compared with non-concurrent operations. These results, however, do not argue against improved and more meaningful disclosure of concurrent surgery practices.

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Section: Methodsmentioning

confidence: 99%

Concurrent bariatric operations and association with perioperative outcomes: registry based cohort study

Liu

Ban

Berian

et al. 2017

BMJ

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“…The current management of the staple line or anastomotic leaks is a step-wise approach. Non-operative and less invasive measures, such as percutaneous drainage, endoscopic repair of leak, and stent, are feasible, safe, and effective for staple line leaks in patients undergoing LSG [ 21 , 22 ]. In the present study, the same approach was applied and the patient recovered in about six weeks of time post-operatively with no residual complications.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Sleeve Gastrectomy: To Suture or not to Suture Staple Line?

Siddiq

Aziz

Khizar

et al. 2018

Cureus

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ObjectiveTo assess the outcome and safety of staple line over-sewing for patients undergoing laparoscopic sleeve gastrectomy (LSG).Study design and locationRetrospective descriptive analysis conducted at Shifa International Hospital Islamabad.Materials and methodsConsecutive patients undergoing LSG as a treatment for morbid obesity from October 2013 to December 2016 were included in the study after approval from the ethical review board. Patients were divided into two groups: group A who underwent reinforcement using Vicryl 2.0 and group B where no reinforcement was done.ResultsA total of 225 patients underwent LSG between October 2013 and December 2016, including 147 females (65.4%) and 78 males (34.6%). Both groups were comparable in terms of age, body mass index (BMI) and gender distribution (p-value more than 0.05). There was one leak in group A (1.36%), none in group B. The bleeding rate was 4.3% in group A and 2.7% in group B.ConclusionThis was a retrospective analysis of all the patients who underwent LSG, and it was observed that there was no added benefit of sewing the staple line in terms of rate of bleeding and leak.

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“…Gentileschi et al 24 randomized 120 patients to suturing, Floseal (Baxter Medical), or SeamGuard with no difference between the groups in leak rate. Berger et al 25 analyzed the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database of 189,477 LSGs and showed that the use of SLR is associated with an increased risk of staple line leak.…”

Section: Discussionmentioning

confidence: 99%

“…Several cohort studies have reported the effect of reinforcement on leak rate. 25 , 26 Noel et al 26 analyzed 2012 LSG cases and reported a significant decrease in leak rate with SLR. Ser et al 27 also reported a positive effect of reinforcement on leak rate, but Stamou et al 28 showed no such positive effect of reinforcement.…”

Section: Discussionmentioning

confidence: 99%

Standardised Sleeve Gastrectomy Without Reinforcement

Lynn

Ilczyszyn

Aguilo

et al. 2018

JSLS

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Background and Objectives:Laparoscopic sleeve gastrectomy (LSG) has some unique complications, the most concerning of which is sleeve leak. Staple line reinforcement (SLR) has been suggested as a means of decreasing the risk of sleeve leak, but it increases the cost. However, there is little in the literature regarding the effect of standardized operative technique in reducing the complications and improving the outcomes in LSG. We sought to demonstrate that standardization of the operative procedure and perioperative care is the key to an excellent 30-day outcome and that SLR is not necessary to ensure a negligible staple line leak and bleeding rate.Methods:A prospectively maintained database was analyzed to identify 303 consecutive patients undergoing LSG between July 2010 and November 2017. Data on patient demographics, length of hospital stay, conversion to open surgery, perioperative complications, and mortality were analyzed. Standardized operative technique and postoperative protocol were followed in all cases. SLR was not used in any case.Results:Among 303 cases, there were 15 complications (5%), 5 (1.7%) of which were severe (Clavien-Dindo grade ≥3a). There were no conversions to open procedure, no staple line leaks, and no inpatient deaths in the cohort. No patient was readmitted with an early stricture.Conclusions:The use of a standardized operative and postoperative protocol led to an excellent early outcome in our LSG cases. Standardization may act to obviate the need for routine SLR techniques which are associated with a significant financial cost to both patient and hospital.

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The Impact of Different Surgical Techniques on Outcomes in Laparoscopic Sleeve Gastrectomies

Cited by 185 publications

References 45 publications

Concurrent bariatric operations and association with perioperative outcomes: registry based cohort study

Concurrent bariatric operations and association with perioperative outcomes: registry based cohort study

Laparoscopic Sleeve Gastrectomy: To Suture or not to Suture Staple Line?

Standardised Sleeve Gastrectomy Without Reinforcement

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