Technical tips associated with reduction in leak rate after laparoscopic sleeve gastrectomy: lessons to learn from a nested case-control study
Mohamed Bekheit1, Khaled Katri2, Wael Abdel-Salam2, Tamer Nabil Abdelbaki3, Bruno Sgromo4, Jean-Marc Catheline5, Galal Abou ElNagah2, El Said El Kayal2
1 Department of Surgery, Alexandria main University Hospital, Faculty of Medicine, University of Alexandria; Minimal Invasive Surgery Unit, Department of Surgery, El Kabbary General Hospital, El Kabbary, Alexandria, Egypt; Centre Hepatobiliare, Paul Brousse Hospital, Villejuif, France
2 Associate Professor of Surgery, Department of Surgery, Alexandria main University Hospital, Faculty of Medicine, University of Alexandria, Egypt
3 Department of Surgery, Alexandria main University Hospital, Faculty of Medicine, University of Alexandria, Egypt
4 Consultant Upper GI and Bariatric Surgeon, Oxford University Hospitals, Oxford, United Kingdom
5 Associate Professor of Surgery, Chief of Gastrointestinal Surgery Unit, Department of Surgery, Delafontaine Hospital, Paris, France
MSc, MRCS, MRCPS, Minimal Invasive Surgery Unit, Department of Surgery, El Kabbary General Hospital, El Kabbary, Alexandria 31241, Egypt
Source of Support: None, Conflict of Interest: None
Laparoscopic sleeve gastrectomy (LSG) is one of the common bariatric procedures for the treatment of morbid obesity. One of the most drastic complications of this procedure is leak.
The aim of the study was to discuss the possible technical factors that might contribute to the occurrence of postoperative leak and how to avoid it through analyzing our series.
Materials and methods
Analysis of the influence of technical adaptations on the outcome of LSG was performed in a nested case-control group of patients. The main modification adapted was performing invaginating sutures over the staple line. The primary outcome was the occurrence of leak. The secondary outcomes were bleeding, operative time, prolonged hospital stay, back pain, and mortality.
The group who had invaginating sutures (group 2) had a significantly lower frequency of leak (0%) than those without invaginating sutures (7.3%; group 1) (PF = 0.016). There was no significant difference in the occurrence of postoperative bleeding or mortality between the groups (PF = 0.162 and 0.250, respectively). The frequencies of a hospital stay longer than 48 h and back pain were significantly higher in group 1 (PF = 0.004, PF < 0.001, respectively).
There were no significant differences between groups in the preoperative BMI (Student's t = 0−0.763, P = 0.45) or the age (Student's t = −0.5, P = 0.61). The operative time was longer in group 1 (Student's t = 3.56, P < 0.001). There was also a significantly lower intraoperative blood loss in group 2 (Student's t = 1.99, P = 0.048).
From our experience, leak after LSG could be minimized by invaginating sutures of the staple line and by adapting the ergonomic trocar positioning described herein.