Abstract
BackgroundMajor 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.MethodsProspectively, 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.ResultsHigh 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.ConclusionsHere, 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.
Highlights
Morbid obesity has become a global epidemic
With growing data and experience, the laparoscopic sleeve gastrectomy (LSG) procedure could be linked to several advantages such as shorter operation time, lack of enteric anastomosis and malabsorption, no or low risk of ulceration and internal hernia, lower rates of dumping syndrome, better patient’s acceptance, feasibility to be converted into multiple other bariatric procedures, maintenance of gastrointestinal continuity with feasibility of endoscopic assessment, lower grade of technical difficulty, and a lower rate of perioperative complications when compared with the bariatric “gold-standard” of laparoscopic Roux-en-Y gastric bypass (LRYGB) [8, 9]
Technical aspects related to stapler misfiring and the type of cartridge used were widely discussed in a recent review by Iossa et al, leading to the statement that appropriate cartridge color should be used based on different stomach wall thickness [14]
Summary
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
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