Laparoscopic Reinforced Sleeve Gastrectomy: Early Results and Complications (original) (raw)

Background Sleeve gastrectomy (SG) was pioneered as a twostage intervention for super and super-super obesity to minimize morbidity and mortality; it is employed increasingly as a primary procedure. Early outcomes and integrity of laparoscopic SG (LSG) against leak using a technique incorporating gastric transection-line reinforcement were studied. Methods Between 2003 and 2009, 121 patients underwent LSG (16, two-stage; 105, primary). Of the patients, 66% were women, mean age 38.8±10.9 (15.0-64.0), and body mass index (BMI, kg/m 2) 48.7±9.3 (33.7-74.8). Bovine pericardium (Peri-Strips Dry [PSD]) was used to reinforce the staple line. Parametric and nonparametric tests were used, as appropriate. The paired t test was used to assess change from baseline; bivariate analyses and logistic regression were used to identify preoperative patient characteristics predictive of suboptimal weight loss. Results Mean operative time was 105 min (95-180), and mean hospitalization was 5.6 days (1-14). There was no mortality. There were 6 (5.0%) complications: 1 intraoperative leak, 1 stricture, 1 trocar-site bleed, 1 renal failure, and 2 wound infections. There were no postoperative staple-line leaks. Following 15 concomitant hiatal hernia operations, 3 (20%) recurred: 1 revised to RYGB and 2 in standby. Two post-LSG hiatal hernias of the two-stage series required revisions because of symptoms. BMI decreased 24.7% at 6 months (n=55) to 37.5±9.3 (22.2-58.1); %EWL was 48.1 ±19.3 (15.5-98.9). Twelve-month BMI (n=41) was 38.4± 10.5 (19.3-62.3); %EWL was 51.7±25.0 (8.9-123.3). Fortyeight-month BMI (n=13) was 35.6±6.8 (24.9-47.5); %EWL was 61.1±12.2 (43.9-82.1) (p<0.001). Preoperative BMI was predictive of >70% of patients who experienced <50% EWL at 6 months. At 2 weeks, 100% of type 2 diabetes patients (n=23) were off medication (mean HbA 1C , 5.9± 0.5%; glycemia, 90.0±19.9 mg/dL (p<0.01) at 3 months). Conclusions Laparoscopic PSD-reinforced LSG as a staged or definitive procedure is safe and effective in the short term and provides rapid type 2 diabetes mellitus reduction with a very low rate of complications.