Impact of the Surgical Experience on Leak Rate After Laparoscopic Sleeve Gastrectomy.

Abstract

Laparoscopic sleeve gastrectomy (LSG) has become one of the most commonly performed bariatric procedures, largely due to several advantages it carries over more complex bariatric procedures. LSG is generally considered a straightforward procedure, but one of the major concerns is a staple line leak. The objectives of this study are to evaluate the correlation between surgeon's experience and leak rate and to assess the different risk factors for developing a gastric leak after LSG. Private hospital, France. The analysis of a single surgeon's yearly leak rate since the introduction of LSG for possible risk factors was done. A total of 2012 LSGs were performed in between September, 2005 and December, 2014. Twenty cases (1%) of gastric leak were recorded. Of these, 17 patients were women (94.4%) with a mean age of 39.4years (range 22-61) and mean body mass index (BMI) 41.2kg/m(2) (range 34.8-57.1). On a yearly basis, the leak rate was 4.8% (2006), 5.7% (2007), 0 (2008), 2.6% (2009), 2% (2010), 0.8% (2011), 0.6% (2012), 0.2% (2013), and 0 (2014). In the first 1000 cases (group A), there were 18 cases of gastric leak and in the last 1000 cases, there were 800 with GORE® SEAMGUARD® Bioabsorbable Staple Line Reinforcement (group B) 2 cases of gastric leak (p = 0.009). A revisional LSG, 395 patients after gastric banding and 61 patients re-sleeve gastrectomy, was performed in 456 cases (22.7%). There were 3 cases of leak (0.65%). There were two deaths. LSG can be performed with a low complication rate. This large series of a single surgeon's experience demonstrated that the leak rate after LSG could be significantly decreased over time with changes in techniques.