Implications of Technical Factors in Development of Early Sleeve Stenosis After Laparoscopic Sleeve Gastrectomy: an Analysis Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Database.

Abstract

Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure worldwide. Sleeve stenosis (SS) is a rare complication of LSG and is associated with significant morbidity and economic burden. The objective of this study was to determine the prevalence and impact of early SS and identify technical factors which may predict its development. Data was extracted from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data registry from 2015 to 2018. Patients undergoing primary LSG were included, while patients undergoing revisional bariatric surgery were excluded. A multivariable logistic regression analysis was performed to identify technical factors associated with SS. A total of 389,839 patients (79.4% female) were included with a mean age of 44.2 ± 12.0 years and mean body mass index of 45.1 ± 7.8 kg/m2. SS was rare, occurring in only 0.09% (n=345) of patients within 30 days of the operation. Following multivariable analysis, technical factors associated with early SS included prolonged operative time > 60 min (OR 1.32, 95% CI 1.17-1.48, p < 0.001) and a shorter PD (OR 0.864, 95% CI 0.784-0.951, p=0.003). For every 1-cm increase in PD, the odds of SS decreased by 13.6%. Overall, early SS is a rare complication, affecting only 0.09% of patients undergoing primary LSG. Technical factors associated with 30-day SS included PD and operative time. Though current guidelines suggest a PD as short as 2 cm, our findings suggest this may be associated with an increased risk of early postoperative SS.