Bariatric Times

Sleeve Gastrectomy 2015

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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April 2015 • Supplement A • Bariatric Times A9 5 th INTERNATIONAL CONSENSUS SUMMIT FOR SLEEVE GASTRECTOMY staple line (Gore ® Seamguard ® Bioabsorbable Staple Line Reinforcement, W. L. Gore & Associates, Flagstaff, Arizona, United States). The results were analyzed using Fisher's Exact Test between the two groups, and the recorded p-value was 0.0011. The use of reinforcement of the staple line along with increased surgeon experience could be equally responsible for the low leak rate observed in Group B. Of interest for further study would be which of these two factors, if any, is most important in LSG leak rates. In the same period, revisional surgery was performed in 387 cases (21%); 345 patients underwent revisional gastric banding and 42 patients underwent resleeve gastrectomy. Three cases of leaks were recorded. There was no significant difference for leak rate, which was 0.77 percent in the revisional LSG group and 1.21 percent in the primary LSG group. DISCUSSION As LSG becomes adopted by more bariatric surgeons, there is a need for the procedure to become standardized to achieve similar results across different practices. Similar results will translate to more awareness of its safety among the public. LSG is not a simple procedure and owing to the fact that the procedure is irreversible, surgeons should strive to minimize the risk of creating strictures at the incisura angularis and stapling near the esophagus at the angle of His. CONCLUSION Our data reveal that LSG can be performed safely with a low complication rate; however, the surgical technique is among the major determinants of the morbidity of this procedure. This review of a large series of a single surgeon's experience demonstrated that the leak rate after LSG could be significantly reduced by surgeon's experience both for primary or revisional bariatric procedures. REFERENCES 1. Lazzati A, Guy-Lachuer R, Delaunay V, Szwarcensztein K, Azoulay D. Bariatric surgery trends in France: 2005–2011. Surg Obes Relat Dis. 2014;10(2):328–334. 2. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23(4):427–436. 3. Fezzi M, Kolotkin RL, Nedelcu M, et al. Improvement in quality of life after laparoscopic sleeve gastrectomy. Obes Surg. 2011;21(8):1161–1167. 4. Noel P, Iannelli A, Sejor E, Schneck AS, Gugenheim J. Laparoscopic sleeve gastrectomy: how I do it. Surg Laparosc Endosc Percutan Tech. 2013 Feb;23(1):e14–e16. 5. Parikh M, Issa R, McCrillis A, Saunders JK, Ude-Welcome A, Gagner M. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg. 2013;257(2):231–237. 6. Sakran N, Goitein D, Raziel A, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc. 2013;27(1):240–245. 7. Ali MR, Tichansky DS, Kothari SN, et al.Validation that a 1-year fellowship in minimally invasive and bariatric surgery can eliminate the learning curve for laparoscopic gastric bypass. Surg Endosc. 2010;24(1):138–144. 8. Geubbels N, de Brauw LM, Acherman YI, van de Laar AW, Wouters MW, Bruin SC. The preceding surgeon factor in bariatric surgery: a positive influence on the learning curve of subsequent surgeons. Obes Surg. 2014 Dec 16. [Epub ahead of print] 9. Bellanger DE, Greenway FL. Laparoscopic sleeve gastrectomy, 529 cases without a leak: short-term results and technical considerations. Obes Surg. 2011; 21(2):146–150. TABLE 1. Yearly distribution of leak YEAR NO. OF CASES LEAK PERCENTAGE 2006 42 2 4.76 2007 54 3 5.66 2008 115 0 0 2009 197 5 2.55 2010 244 5 2.04 2011 248 2 0.81 2012 341 2 0.58 2013 408 1 0.23 2014 151 0 0 TABLE 2. Surgeon's experience distribution GROUP A GROUP B First 900 cases Last 900 cases Sept. 2005– Dec. 2011 Jan. 2012–July 2014 18 leaks (2%) 2 leaks (0.22%) p value=0.0011

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