Aman B Ali1,2, Lee M Morris3,1, Jeffrey Hodges1, Farshad Amirkhosravi1, Sara Yasrebi1, Amelia Khoo1, Edward A Graviss4, Duc T Nguyen4, Patrick R Reardon5,6. 1. Department of Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA. 2. Division of Minimally Invasive Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, Wang 460E, Boston, MA, 02114, USA. 3. Division of Minimally Invasive Surgery, Department of Surgery, Houston Methodist Hospital, 6550 Fannin Street, Smith Tower, Suite 1661, Houston, TX, 77030, USA. 4. Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA. 5. Division of Minimally Invasive Surgery, Department of Surgery, Houston Methodist Hospital, 6550 Fannin Street, Smith Tower, Suite 1661, Houston, TX, 77030, USA. Reardonp@houstonmethodist.org. 6. Department of Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA. Reardonp@houstonmethodist.org.
Abstract
BACKGROUND: Over 100,000 sleeve gastrectomy procedures are performed annually in the USA. Despite technological advances, postoperative bleeding and gastric staple line leak are complications of this procedure. We analyzed patient-specific and perioperative factors to determine their association with these complications. METHODS: We performed a retrospective cohort analysis of patients who underwent sleeve gastrectomy between 2005 and 2019 at our institution. Patient demographics, comorbidities, and procedure details including type of energy device, staple type, staple height, staple line oversewing, and staple line clipping were compared using multiple logistic regression for combined postoperative complications (blood transfusion, bleeding, and staple line leak). Postoperative bleeding was defined by requiring blood transfusion and/or re-operation to control bleeding. Staple line leak was confirmed radiographically. RESULTS: There were 1213 patients who underwent sleeve gastrectomy. Fifty-two high-risk patients were excluded due to cirrhosis, end-stage renal disease, and anticoagulation use for left ventricular assist device. Of the remaining 1161 patients, twenty-five (2.2%) received postoperative blood transfusion, nine (0.8%) had postoperative bleeding, two (0.2%) had staple line leak, and twenty-eight patients (2.4%) had combined postoperative complications. The median age was significantly higher for patients with combined postoperative complications (43 vs 49; p = 0.02). There was no difference in postoperative blood transfusion, bleeding, staple line leak, or combined postoperative complication with different energy devices (p = 0.92), staple types (p = 0.21), staple heights (p = 0.50), or staple line suturing/clipping (p = 0.95). In addition, there was no difference in bleeding when comparing staple line sewing techniques (p = 0.44). Predictably, patients with combined postoperative complications had increased length of stay (3 days vs 1 day; p < 0.001). CONCLUSION: Sleeve gastrectomy procedure has tremendous variability in technique and devices used. We observed no difference in the combined postoperative complications of bleeding or staple line leak with respect to different energy devices, staple height, or oversewing of the gastric staple line. Patient selection is crucial, as patient age and coagulopathic comorbidities were found to lead to higher combined postoperative complications.
BACKGROUND: Over 100,000 sleeve gastrectomy procedures are performed annually in the USA. Despite technological advances, postoperative bleeding and gastric staple line leak are complications of this procedure. We analyzed patient-specific and perioperative factors to determine their association with these complications. METHODS: We performed a retrospective cohort analysis of patients who underwent sleeve gastrectomy between 2005 and 2019 at our institution. Patient demographics, comorbidities, and procedure details including type of energy device, staple type, staple height, staple line oversewing, and staple line clipping were compared using multiple logistic regression for combined postoperative complications (blood transfusion, bleeding, and staple line leak). Postoperative bleeding was defined by requiring blood transfusion and/or re-operation to control bleeding. Staple line leak was confirmed radiographically. RESULTS: There were 1213 patients who underwent sleeve gastrectomy. Fifty-two high-risk patients were excluded due to cirrhosis, end-stage renal disease, and anticoagulation use for left ventricular assist device. Of the remaining 1161 patients, twenty-five (2.2%) received postoperative blood transfusion, nine (0.8%) had postoperative bleeding, two (0.2%) had staple line leak, and twenty-eight patients (2.4%) had combined postoperative complications. The median age was significantly higher for patients with combined postoperative complications (43 vs 49; p = 0.02). There was no difference in postoperative blood transfusion, bleeding, staple line leak, or combined postoperative complication with different energy devices (p = 0.92), staple types (p = 0.21), staple heights (p = 0.50), or staple line suturing/clipping (p = 0.95). In addition, there was no difference in bleeding when comparing staple line sewing techniques (p = 0.44). Predictably, patients with combined postoperative complications had increased length of stay (3 days vs 1 day; p < 0.001). CONCLUSION: Sleeve gastrectomy procedure has tremendous variability in technique and devices used. We observed no difference in the combined postoperative complications of bleeding or staple line leak with respect to different energy devices, staple height, or oversewing of the gastric staple line. Patient selection is crucial, as patient age and coagulopathic comorbidities were found to lead to higher combined postoperative complications.
Authors: Franz X Felberbauer; Felix Langer; Soheila Shakeri-Manesch; Elisabeth Schmaldienst; Mathias Kees; Stephan Kriwanek; Manfred Prager; Gerhard Prager Journal: Obes Surg Date: 2008-04-08 Impact factor: 4.129
Authors: Ann Y Chung; Paula D Strassle; Francisco Schlottmann; Marco G Patti; Meredith C Duke; Timothy M Farrell Journal: J Gastrointest Surg Date: 2019-04-22 Impact factor: 3.452
Authors: Wayne J English; Eric J DeMaria; Matthew M Hutter; Shanu N Kothari; Samer G Mattar; Stacy A Brethauer; John M Morton Journal: Surg Obes Relat Dis Date: 2020-01-03 Impact factor: 4.734