Larger gastric sleeves during laparoscopic sleeve gastrectomy may reduce leaks without impacting weight loss
Laparoscopic sleeve gastrectomy (LSG) is a bariatric surgical procedure that removes 80 percent of the stomach’s volume by stapling the stomach into a smaller sleevelike pouch. The procedure is performed by firing a surgical stapler along an orogastric bougie (used to size the sleeve). Debate exists about whether creating tighter (i.e., smaller) sleeves to achieve more weight loss comes at the expense of higher leak rates that can cause infection and prolonged hospital stay.
A new systematic review and meta-analysis of 9,991 patients who underwent LSG, found lower leak rates with large gastric sleeves without any affect on weight loss. The meta-analysis found that the risk of leaks decreased by 47 percent when the bougie used to calibrate the sleeve was at least 40 Fr. Leak rates were 2.5 percent for bougie size under 40 Fr, 1.7 percent for bougie sizes 40–49 Fr, and 0.9 percent for bougie size at least 50 Fr. However, 69 percent of the patients had a bougie less than 40 Fr in size. The researchers reported that a total of 198 leaks occurred, an incidence of 2.2 percent among 8,922 LSG patients.
When the researchers examined the effect of bougie size on the percent of excess weight loss, they found no significant difference for up to 36 months between those with bougie size less than 40 Fr and those with bougie size 40 Fr or greater. Neither the distance between the LSG transection from the pylorus (at least 5 cm in 68 percent of those patients for which it was known) nor the type of material used to buttress the staple line impacted the likelihood of a leak.
The researchers call for longer-term studies to conclusively establish the effect of bougie size on weight loss after LSG. Their findings were based on data on 9,991 LSG patients from 112 studies. The review was funded in part by AHRQ (HS19473).
More details are in "Surgical strategies that decrease leak after laparoscopic sleeve gastrectomy. A systematic review and meta-analysis of 9991 cases," by Manish Parikh, M.D., Redda Issa, B.A., Aileen McCrillis M.L.I.S., and others in the February 2013 Annals of Surgery 257(2), pp. 231-237.