Impact of Resection Volume/Stapler Firings-Ratio on Perioperative Complications and Weight Loss After Laparoscopic Sleeve Gastrectomy

The Effect of Gluing Versus Suturing of the Stapler Line in Sleeve Gastrectomy on Weight Loss

BACKGROUND

Stapler line reinforcement during sleeve gastrectomy (LSG) was assessed thoroughly in the context of postoperative complications focusing on leakage and bleeding. However, the effect of stapler line reinforcement techniques on the short- and long-term weight loss is still unclear and lacking. We hypothesize that inverting of the stapler line by Lembert suturing could lead to further additional reduction of the remnant gastric volume and accordingly a more significant weight reduction.

METHODS

Retrospective analysis of patients that underwent LSG (2012-2018) from the two university hospitals. The first hospital routinely performed oversewing with inversion of the stapler line (first group, Lembert suture), while the second university hospital performed LSG without stapler line oversewing and inversion, but routinely used VeraSeal glue (second group, non-Lembert); both groups were compared in terms of weight loss and complications.

RESULTS

Four hundred eighty and 550 patients underwent LSG in the first and second hospital, consequently. The mean BMI change and EBWL at 1, 3, and 5 years were better in the first group than in second group. The mean last follow-up BMI was significantly lower in Lembert group (29.8 ± 5.2kg/m2) than in non-Lembert group (32.9 ± 6.7 kg/m2), P = 0.001. The mean EBWL at last follow-up point was significantly better for the Lembert group as compared to non-Lembert group (73.7 ± 26.59 versus 57.12 ± 27.71, P = 0.001).

CONCLUSIONS

Lembert suture line oversewing and inversion in LSG is associated with noticeable improvement in weight loss outcomes at 1, 3, and 5 years and last follow-up compared to LSG with VeraSeal gluing.

Resected gastric volume/number of staplers fired ratio as a tool in predicting complication and midterm results in sleeve gastrectomy

Laparoscopic sleeve gastrectomy is a restrictive surgery that aims to decrease the gastric volume of the patient. This study hypothesized that a higher resected gastric volume to the number of fired staplers ratio is associated with improved postoperative 12th-month outcomes. To analyze the effects of resected gastric volume to the number of fired staplers ratio on postoperative results in patients who underwent sleeve gastrectomy. University Hospital, Istanbul, Türkiye. We analyzed the data of 407 patients who underwent laparoscopic sleeve gastrectomy between 2018 and 2022. The primary outcome was the effect of resected gastric volume to the number of fired staplers ratio on excess weight loss at 12 months postoperatively. A total of 407 patients were included in the study. The higher resected gastric volume to the number of fired staplers ratio was associated with higher excess weight loss in the postoperative 12th month, while no significant effect was found on complications (p = 0.001 and p = 0.785, respectively). This study revealed resected gastric volume to the number of fired staplers ratio could be used to predict weight loss. Further studies should examine the effect of resected gastric volume to number of fired staplers ratio on postoperative complications.

Can Weight of The Resected Stomach Predict Weight Loss Results After Laparoscopic Sleeve Gastrectomy?

BACKGROUND

Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure worldwide. Many factors have been investigated in the literature to predict weight loss outcomes after LSG. However, insufficient data regarding the resected stomach weight (RGW) exists. This retrospective study aimed to investigate the association between RGW and weight loss outcomes 1 year after LSG.

MATERIALS AND METHODS

Fifty-four patients who underwent LSG in a tertiary care center were evaluated retrospectively. The statistical analyses were performed to investigate the correlation between preoperative demographics, RGW, and the excess weight loss percentage (%EWL) and percent total weight loss (%TWL).

RESULTS

The mean RGW was 169.7±40.1, ranging from 101 to 295 grams. The RGW was significantly correlated with preoperative weight (r=0.486; P<0.001), body mass index (r=0.420; P=0.002), and age (r=0.327; P=0.01). However, RGW did not predict postoperative weight loss, as measured by percent total weight loss (%TWL) and percent excess weight loss (%EWL), respectively (r=0.044; P=0.75 and r=-0.216; P=0.11). Multiple linear regression analysis identified age as a negative predictor for both %TWL (β=-0.351, P=0.005) and %EWL (β=-0.265, P=0.03), while preoperative body mass index was a negative predictor for %EWL (β=-0.469, P<0.001).

CONCLUSION

The RGW, although correlated with patient characteristics, does not serve as a reliable predictor of postoperative weight loss in the first year after LSG. Further research is needed to improve predictive models and patient care in bariatric surgery.

Vasoconstrictor nasal spray causing life-threatening complications after bariatric surgery: A case report

Introduction and importance

Bariatric surgery is an evolving surgical field with increasing cases per year, as obesity is prevalent, especially in developed countries. Complication diagnosis and management can be challenging. Marginal ulcers and anastomosis perforation are rare, but their incidence is likely underestimated.

Case presentation

To the best of our knowledge, we present the first case with a two and a half years history of recurrent ischemia, marginal ulcers, and recurrent perforation after laparoscopic omega loop gastric bypass, most likely due to an abuse of an over-the-counter (OTC) sympathomimetic nasal spray. The complications (Clavien-Dindo classification IIIb) caused the necessity of recurrent hospitalizations and diagnostic interventions and an open conversion into Roux-Y gastric bypass in a damage control manner.

Clinical discussion and conclusion

Conclusively, we advocate evaluating drug abuse, including OTC medications that patients might not report on a daily-based medical history, as an etiology for marginal ulcers and anastomosis perforation, especially in late and recurrent cases.

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Abuse of OTC sympathomimetic nasal spray can cause recurrent gastrojejunal anastomosis ischemia.

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Re-Do surgery cannot prevent recurrence of ischemia in these cases.

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In recurrence of ischemia, detailed medical history, including OTC drugs, is crucial.