Laparoscopic Sleeve Gastrectomy With or Without Staple Line Inversion and Distal Fixation to the Transverse Mesocolon: Impact on Early Postoperative Outcomes

Abstract

Staple line complications and axial rotation of the gastric tube after sleeve gastrectomy are well-recognized complications of the procedure. The present study aims to investigate the role of staple line inversion and distal fixation to the transverse mesocolon in reducing these complications. This is a retrospective analysis of prospectively collected data of 252 patients with morbid obesity who underwent laparoscopic sleeve gastrectomy (LSG). Patients were subdivided into two groups: group I comprising 124 patients did not have distal sleeve fixation and group II comprising 128 patients underwent staple line inversion and distal fixation. Patients were 171 females and 81 males with a mean age of 33.2±8.7years and a mean preoperative body mass index (BMI) of 50.9±8.6 Kg/m2. The mean operating time was 103.9±26.9min and the median hospital stay was 1day. Major complications were detected in 15 (5.9%) patients, who were all in group I. Group I had significantly shorter operative time and significantly higher rates of staple line bleeding (4% in group I versus 0 in group II) and gastric axial rotation (5.6% in group I versus 0 in group II). There were no significant differences between the two groups regarding early postoperative vomiting (21.7% versus 26.5%) and staple line leak (2.4% versus 0). Staple line inversion and distal fixation to the transverse mesocolon can be a simple, effective strategy to prevent staple line bleeding, and gastric axial rotation, though it prolonged the operative time of LSG.