Article 9 LAPAROSCOPIC SLEEVE GASTRECTOMY WITH STAPLE LINE BUTTRESS REINFORCEMENT IN 116 CONSECUTIVE MORBIDLY OBESE PATIENTS
CITATION
Gill RS, Switzer N, Driedger M, et al. Laparoscopic sleeve gastrectomy with staple line buttress reinforcement in 116 consecutive patients with morbid obesity. Obes Surg. 2012;22:560–564.
PURPOSE OF THE STUDY
The purpose of this study is to assess the effectiveness of staple line buttress reinforcement with the use of the Duet™
tissue reinforcement
stapler (TRS) system on staple line complications in patients with morbid obesity undergoing laparoscopic sleeve gastrectomy (LSG). This study focuses on postoperative outcomes, such as complications, mean weight loss, and mean change in comorbidity BMI improvement.
METHODS
This is a retrospective review of prospectively collected data from 116 LSG consecutive cases performed with staple line reinforcement using the Duet™
TRS between January
2008 and April 2011. Patients who underwent surgery were at least 18 years of age and had a BMI >40kg/m2 or BMI >35kg/m2
with comorbidities.
All patients participated in a comprehensive adult weight management program, which included the completion of at least six months of primary care weight management intervention, nutrition counseling, and initiation of a physical activity or walking program. Participants were required to be nonsmokers for a minimum of 3 months prior to the procedure.
RESULTS
• Mean length of hospital stay was 2.4±1 days.
• Mean operative time was 96±25 minutes.
• 5 major complications occurred within a 30-day follow up period: 1 case of bleeding occurred from gastric staple line; 3 wound infections; 1 patient developed dyspnea.
• No gastric leaks were observed in 108 consecutive patients with
staple line buttress reinforcement.
• Mean weight upon entering into the weight loss program was 140±28kg; prior to procedure mean weight was 125±25kg; at 1 year follow up mean weight was significantly less at 104±25kg (P<0.05).
• 1 year following LSG, mean BMI was 37±8 kg/m2
, which is
significantly reduced from the initial mean BMI of 50±8kg/m2 (P<0.05).
• HbA1c levels significantly improved in patients with type 2 diabetes mellitus (T2MD) from 6.9±1.7 to 6.3±1.5 following LSG at 6-month follow-up (P=0.04). HbA1c levels continued to improve in 11 of 18 patients at 1-year follow up.
CONCLUSION
LSG with staple line buttress reinforcement via the Duet™ TRS in patients with morbid obesity limits postoperative staple line gastric leakage and bleeding.
20S
Bariatric Times • June 2012 • Supplement