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Zobel LB, Dhimolea S, Billeci F, Sbraccia P, Sica GS. Laparoscopic Sleeve Gastrectomy with Staple-Line Oversewing in a Patient with Factor XI Deficiency: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e942824. [PMID: 38654503 PMCID: PMC11056211 DOI: 10.12659/ajcr.942824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/14/2024] [Accepted: 12/19/2023] [Indexed: 04/26/2024]
Abstract
BACKGROUND Bariatric surgery (BS) has a lower percentage of complications than other abdominal surgeries. Hemorrhage in one of the most common complications and can be life-threatening. Hereditary factor XI (FXI) deficiency is a coagulation disorder that can result in excessive bleeding requiring intervention to restore hemostasis. Risks over benefits in patients with morbid obesity with BS indication, as well as those with FXI deficiency, should be carefully evaluated. This article reports the case of an obese woman with FXI deficiency -undergoing SG. CASE REPORT A 49-year-old woman with a BMI of 51 kg/m² was diagnosed as having severe FXI deficiency during preoperative exams prior to bariatric surgery. Virus-inactivated homo-group plasma 10 ml/kg infusion was administrated 1 h before surgery, during the entire procedure, and continuing until postoperative day (POD) 4. A very low-calorie ketogenic diet (VLCKD) was proposed to the patient 4 weeks before surgery. Laparoscopic sleeve gastrectomy was performed with staple-line reinforcement by oversewing the seromuscular layer using continuous suture. Subcutaneous enoxaparin 4000 U.I. was administered from POD 1 until POD 25 to prevent any thromboembolic event. The patient was discharged on POD 5 in good clinical condition. CONCLUSIONS Risks of bleeding andor thromboembolic events before or after BS are increased in patient with FXI deficiency. Bariatric surgery in these patients is safe in experienced BS centers, and the risks associated with the obesity seem to exceed those of the coagulopathy and surgery. Careful preoperative counseling, extensive hematological checks, and meticulous surgery are essential to reduce BS risks. Sleeve gastrectomy oversewing the stapler line seems a reasonable choice.
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Affiliation(s)
- Lorenza Beomonte Zobel
- Minimally Invasive Unit, Department of Surgical Science, University and Policlinico Tor Vergata, Rome, Italy
| | - Sirvjo Dhimolea
- Minimally Invasive Unit, Department of Surgical Science, University and Policlinico Tor Vergata, Rome, Italy
| | - Federica Billeci
- Minimally Invasive Unit, Department of Surgical Science, University and Policlinico Tor Vergata, Rome, Italy
| | - Paolo Sbraccia
- Internal Medicine Unit and Obesity Center, Department of Systems Medicine, University and Policlinico Tor Vergata, Rome, Italy
| | - Giuseppe S. Sica
- Minimally Invasive Unit, Department of Surgical Science, University and Policlinico Tor Vergata, Rome, Italy
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Manara M, Aiolfi A, Sozzi A, Calì M, Grasso F, Rausa E, Bonitta G, Bonavina L, Bona D. Short-Term Outcomes Analysis Comparing Open, Laparoscopic, Laparoscopic-Assisted, and Robotic Distal Gastrectomy for Locally Advanced Gastric Cancer: A Randomized Trials Network Analysis. Cancers (Basel) 2024; 16:1620. [PMID: 38730574 PMCID: PMC11083793 DOI: 10.3390/cancers16091620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/16/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Minimally invasive surgery for the treatment of locally advanced gastric cancer (AGC) is debated. The aim of this study was to execute a comprehensive assessment of principal surgical treatments for resectable distal gastric cancer. METHODS Systematic review and randomized controlled trials (RCTs) network meta-analysis. Open (Op-DG), laparoscopic-assisted (LapAs-DG), totally laparoscopic (Lap-DG), and robotic distal gastrectomy (Rob-DG) were compared. Pooled effect-size measures were the risk ratio (RR), the weighted mean difference (WMD), and the 95% credible intervals (CrIs). RESULTS Ten RCTs (3823 patients) were included. Overall, 1012 (26.5%) underwent Lap-DG, 902 (23.6%) LapAs-DG, 1768 (46.2%) Op-DG, and 141 (3.7%) Rob-DG. Anastomotic leak, severe complications (Clavien-Dindo > 3), and in-hospital mortality were comparable. No differences were observed for reoperation rate, pulmonary complications, postoperative bleeding requiring transfusion, surgical-site infection, cardiovascular complications, number of harvested lymph nodes, and tumor-free resection margins. Compared to Op-DG, Lap-DG and LapAs-DG showed a significantly reduced intraoperative blood loss with a trend toward shorter time to first flatus and reduced length of stay. CONCLUSIONS LapAs-DG, Lap-DG, and Rob-DG performed in referral centers by dedicated surgeons have comparable short-term outcomes to Op-DG for locally AGC.
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Affiliation(s)
- Michele Manara
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (M.M.); (D.B.)
| | - Alberto Aiolfi
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (M.M.); (D.B.)
| | - Andrea Sozzi
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (M.M.); (D.B.)
| | - Matteo Calì
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (M.M.); (D.B.)
| | - Federica Grasso
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (M.M.); (D.B.)
| | - Emanuele Rausa
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (M.M.); (D.B.)
| | - Gianluca Bonitta
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (M.M.); (D.B.)
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, 20097 Milan, Italy;
| | - Davide Bona
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (M.M.); (D.B.)
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Hossain N, Kaur V, Mahran M, Quddus A, Mukhopadhyay S, Shah A, Agrawal S. Intra-operative Tranexamic Acid Administration Significantly Decreases Incidence of Postoperative Bleeding Without Increasing Venous Thromboembolism Risk After Laparoscopic Sleeve Gastrectomy: a Retrospective Cohort Study of Over 400 Patients. Obes Surg 2024; 34:396-401. [PMID: 38168716 DOI: 10.1007/s11695-023-07021-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND There is evidence that tranexamic acid (TXA) reduces surgical bleeding and is widely used in trauma, obstetrics and other specialties. This practice is less well-established in laparoscopic sleeve gastrectomy (LSG) due to concerns surrounding venous thromboembolism (VTE); equally postoperative bleeding is a serious complication often requiring re-operation. METHODS This retrospective cohort study compared 30-day outcomes following primary LSG in patients receiving intra-operative TXA (March 2020-July 2022) to those who did not (March 2011-March 2020). The primary outcome was postoperative bleeding (Hb < 9 g/dL) requiring transfusion or re-operation. Secondary outcomes were incidence of VTE, serious postoperative complications (Clavien-Dindo > grade 3) and death. Patients underwent standardised-protocol LSG without staple line re-enforcement under a single surgeon within the independent sector (private practice). TXA 1 g intravenous was administered immediately after a methylene blue leak test, prior to extubation. RESULTS TXA group had 226 patients and non-TXA group had 192 patients. Mean age was 40.5 ± 10.3 and 39.1 ± 9.8 years, respectively. In the TXA group, no postoperative bleeds [versus 3 (1.6%) in non-TXA group, p = 0.0279] occurred. One staple line leak (0.4%) occurred in the TXA group compared to zero in the non-TXA group (p = ns). There was no VTE or death. CONCLUSIONS This is the largest cohort study of intra-operative TXA in primary LSG to date, which demonstrates significant decrease in postoperative bleeding without increasing VTE risk. The authors recommend administration of TXA immediately following leak test, or removal of bougie to maximise efficacy. Data of TXA in LSG is awaited from the randomised controlled PATAS trial.
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Affiliation(s)
- Naveed Hossain
- Department of Bariatric Surgery, Homerton University Hospital, Homerton Row, London, E9 6SR, UK
| | - Vasha Kaur
- Department of Bariatric Surgery, Homerton University Hospital, Homerton Row, London, E9 6SR, UK
| | - Mostafa Mahran
- Department of Bariatric Surgery, Homerton University Hospital, Homerton Row, London, E9 6SR, UK
| | - Abdul Quddus
- Department of Bariatric Surgery, Homerton University Hospital, Homerton Row, London, E9 6SR, UK
| | - Santanu Mukhopadhyay
- Department of Anaesthesia, Homerton University Hospital, Homerton Row, London, E9 6SR, UK
| | - Akshat Shah
- Department of Anaesthesia, Homerton University Hospital, Homerton Row, London, E9 6SR, UK
| | - Sanjay Agrawal
- Department of Bariatric Surgery, Homerton University Hospital, Homerton Row, London, E9 6SR, UK.
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Gönüllü E, Yüksel A, Coşkun M, Harmantepe T, Fırtına G, Karaman K. Oversewing the Staple Line: Does It Safe to Prevent Leakage? J Laparoendosc Adv Surg Tech A 2024; 34:120-126. [PMID: 37934468 DOI: 10.1089/lap.2023.0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Abstract
Introduction: The staple line (SL) leak remains one of the most serious complications after laparoscopic sleeve gastrectomy (LSG). The present study aims to determine whether reinforcing the SL with sutures is effective in maintaining tissue integrity. Materials and Methods: LSG Specimens of 60 patients were ex vivo studied. The specimens were divided into three groups: In group 1, the entire SL was reinforced, while the upper half part of the SL was reinforced from fundus to antrum in group 2. The SL was not reinforced in group 3. Then, the pressure inside the sample was increased, and the bursting pressure location and pressure value during the bursting were recorded. Results: The bursting pressure was significantly higher in entire and half oversewed SL groups than the none reinforced group (group 1: 115 mmHg [95-170]; group 2: 95 mmHg [80-120]; group 3: 40 mmHg [22-60], respectively, [P < .001]). The most common site of bursting was in the middle ⅓ of SL (35, 53.8%), followed by the proximal ⅓ part of SL (18, 27.7%), and the distal ⅓ part of SL (12, 18.5%), respectively. The bursting site was significantly more frequent in the corpus than the other parts of the SL (P = .013). Conclusion: Reinforcing the SL with sutures preserves tissue integrity. Although bursting was most frequently observed in the corpus region ex vivo, the fact that almost all real-life leaks develop in the area close to the Angle of His. This situation suggests that strengthening the suture line with reinforcement alone will not be protective enough against leaks in the fundus line, and factors such as tissue ischemia may be considered.
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Affiliation(s)
- Emre Gönüllü
- Gastrointestinal Surgery Department, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Adem Yüksel
- Gastrointestinal Surgery Department, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Murat Coşkun
- General Surgery Department, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Tarık Harmantepe
- General Surgery Department, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Gizem Fırtına
- Gastrointestinal Surgery Department, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Kerem Karaman
- Gastrointestinal Surgery Department, Sakarya University Faculty of Medicine, Sakarya, Turkey
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Wang S, Zhang Y, Tao S, Liu Y, Shi Y, Guan J, Liu M. Efficacy of reinforcing sutures for prevention of anastomotic leakage after low anterior resection for rectal cancer: A systematic review and meta-analysis. Cancer Rep (Hoboken) 2024; 7:e1941. [PMID: 38174618 PMCID: PMC10849930 DOI: 10.1002/cnr2.1941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/31/2023] [Accepted: 11/11/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Anastomotic leakage is a serious complication following surgery for cancer of the rectum. It is not clear whether reinforcing sutures could prevent anastomotic leakage. Therefore, this study aims at evaluating the efficacy of reinforcing sutures on anastomotic leakage. METHODS We searched PubMed, Embase, and the Cochrane Library databases from inception to January 31, 2023. We included studies comparing anastomosis with reinforcing sutures to anastomosis without reinforcing sutures after low anterior resection. Risk of bias was assessed by the Cochrane tool for RCTs and the Risk of Bias in Non-Randomized Studies (ROBINS)-I tool for observational studies. The overall quality of evidence for primary outcome was assessed using Grading of Recommendations Assessment, Development, and Evaluations methodology. RESULTS Two RCTs (345 patients) and four observational studies (783 patients) were included. Anastomotic leakage occurred in 4.4% (24 of 548) of patients with reinforcing sutures and 11.9% (69 of 580) of patients without reinforcing sutures. Meta-analysis showed a lower incidence of anastomotic leakage (RR, 0.41; 95% CI 0.25 to 0.66, low certainty) in patients with reinforcing sutures. Operative time (WMD, -3.66; 95% CI -18.58 to 11.25) and reoperation for anastomotic leakage (RR, 0.69; 95% CI 0.23 to 2.08) were similar between patients with reinforcing sutures and those without reinforcing sutures. CONCLUSIONS While observational data suggest that, there is a clear benefit in terms of reducing the risk of anastomotic leakage with the use of reinforcing sutures, RCT data are less clear. Further large, prospective studies are warranted to determine whether a true clinically important benefit exists with this technique.
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Affiliation(s)
- Shuanhu Wang
- Department of Gastrointestinal surgeryThe First Affiliated Hospital of Bengbu Medical CollegeBengbuAnhuiChina
| | - Yi Zhang
- Department of Gastrointestinal surgeryThe First Affiliated Hospital of Bengbu Medical CollegeBengbuAnhuiChina
| | - Song Tao
- Department of Gastrointestinal surgeryThe First Affiliated Hospital of Bengbu Medical CollegeBengbuAnhuiChina
| | - Yakui Liu
- Department of Gastrointestinal surgeryThe First Affiliated Hospital of Bengbu Medical CollegeBengbuAnhuiChina
| | - Yi Shi
- Department of Gastrointestinal surgeryThe First Affiliated Hospital of Bengbu Medical CollegeBengbuAnhuiChina
| | - Jiajia Guan
- Department of Gastrointestinal surgeryThe First Affiliated Hospital of Bengbu Medical CollegeBengbuAnhuiChina
| | - Mulin Liu
- Department of Gastrointestinal surgeryThe First Affiliated Hospital of Bengbu Medical CollegeBengbuAnhuiChina
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Xie Y, Wen J, Zhu H, Liu Y. The Effects of Reinforcement Techniques in Sleeve Gastrectomy and Roux-en-Y Gastric Bypass: Protocol for a Web-Based Survey, Systematic Review, and Meta-Analysis. JMIR Res Protoc 2023; 12:e50677. [PMID: 38133924 PMCID: PMC10770791 DOI: 10.2196/50677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The effects of reinforcement are still controversial in bariatric surgery, and variations may exist in using this technique. OBJECTIVE This protocol describes a study that aims to survey the views of bariatric surgeons on reinforcement techniques and evaluate the effects of applying reinforcement techniques in sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). METHODS This study is composed of 2 parts. Part 1 will investigate the differences of using reinforcement techniques among surgeons worldwide who perform SG or RYGB through a survey. The survey will be conducted by email and social media. Part 2 will evaluate the safety and effectiveness of using omentopexy or staple line reinforcement in SG and RYGB by systematic review and meta-analysis. In this part, literature searches will be performed in English databases, including CENTRAL, EMBASE CINAHL, Web of Science, and PubMed, and Chinese databases, including Wanfang, China National Knowledge Infrastructure, Database of Chinese Technical Periodicals, and Chinese Biological Medicine, from their establishment to November 2023. Randomized controlled trials and case-control studies will be included. The primary outcomes are rates of postoperative bleeding and gastric leakage. The secondary outcomes include anastomotic stenosis, surgical site infection, reoperation, estimated intraoperative blood loss, operative time (minutes), length of hospital stay (days), overall complications, and 30-day mortality. The meta-analysis will be conducted using RevMan 5.4 under the random-effects model, as well as through extensive subgroup and sensitivity analyses. P values <0.05 will be considered statistically significant. This study was registered with PROSPERO (Prospective Register of Systematic Reviews) in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols). RESULTS The results of this study will be published in a peer-reviewed journal. The web-based survey and initial title or abstract review of papers identified by the search strategy will be completed in November 2023. The second round of title or abstract review and downloading of the papers for full-text inclusion will be completed in January 2024. We aim to complete data extraction and meta-analysis by February 2024 and expect to publish the findings by the end of March 2024. CONCLUSIONS This study aims to investigate the impact of reinforcement techniques on reducing the incidence of postoperative complications in SG and RYGB procedures and provide assistance for standardizing the procedures of SG and RYGB operations for bariatric surgeons. TRIAL REGISTRATION PROSPERO CRD42022376438; https://tinyurl.com/2d53uf8n. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/50677.
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Affiliation(s)
- Yunhui Xie
- Center of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Jun Wen
- College of Medicine, Southwest Jiaotong University, Chengdu, China
| | - Hongmei Zhu
- Center of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Yanjun Liu
- Center of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
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Sermet M, Ozsoy MS. Effect of Tranexamic Acid on Postoperative Bleeding in Sleeve Gastrectomy: a Randomized Trial. Obes Surg 2023; 33:3962-3970. [PMID: 37857939 DOI: 10.1007/s11695-023-06902-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/07/2023] [Accepted: 10/11/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE Research on the timing and efficacy of tranexamic acid (TXA) use for perioperative bleeding in bariatric surgery is lacking. To evaluate the effects of TXA use on clinical outcomes in laparoscopic sleeve gastrectomy (LSG) by comparing TXA use at the beginning of induction with TXA use at the end of surgery and placebo use. MATERIALS AND METHODS Between February 2022 and August 2022, 177 patients were randomized into three groups: TXA administered at the beginning of induction (TXAI), TXA administered at the end of surgery (TXAP), and placebo groups. Preoperative and postoperative care was standardized, and all patients received LSG. Analyzed using ANOVA, Mann-Whitney U test, and Student's t-test. RESULTS No significant difference was observed between the groups in terms of operative time and blood loss. There were significantly fewer intraoperative bleeding points in the TXAI group compared to the other groups (P < 0.05). Postoperative bleeding was significantly lower in the TXAI and TXAP groups compared to the placebo group (P < 0.05). Hemoglobin and CRP levels showed significant differences between the groups. TXA administration did not cause a significant decrease in coagulation values, and there were no cases of venous thromboembolism (VTE) during the follow-up period. CONCLUSION This study provides evidence that TXA administered during LSG is effective in reducing postoperative bleeding. No data were obtained regarding the superiority of TXA administration at the beginning of induction and at the end of surgery. TRIAL REGISTRATION ClinicalTrials.gov with the registration code NCT05696951, 25 January 2023: https://www. CLINICALTRIALS gov/study/NCT05696951 .
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Affiliation(s)
- Medeni Sermet
- Department of General Surgery, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Medeniyet University, Dr. Erkin Street No:3, 34732 Kadikoy, Istanbul, Turkey.
| | - Mehmet Sait Ozsoy
- Department of General Surgery, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Medeniyet University, Dr. Erkin Street No:3, 34732 Kadikoy, Istanbul, Turkey
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El Masry MAMA, Attia MS. A comparative study between staple line reinforcement during laparoscopic sleeve gastrectomy and no reinforcement: an Egyptian experience. Surg Endosc 2023; 37:9318-9325. [PMID: 37891370 PMCID: PMC10709468 DOI: 10.1007/s00464-023-10497-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/23/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has become an increasingly popular bariatric procedure. LSG still conveys some risks, including early staple line complications such as bleeding and leaks. It has been proposed that staple line complications can be reduced by staple line reinforcement (SLR). This study aimed to compare the short-term efficacy and safety of the SLR during LSG by oversewing versus no SLR in an Egyptian cohort over a period of 11 years. PATIENTS AND METHODS This is a retrospective study that analyzed data from patients undergoing LSG by the same surgeon over a period of 11 years. The patients' early postoperative complications were compared according to performing SLR. RESULTS The SLR group showed significantly longer surgery time (p = 0.021) and a lower rate of postoperative bleeding (p = 0.027). All leakage cases occurred in the non-SLR group (0.7% vs. 0.0%) without statistical significance (p = 0.212). The two mortality cases occurred in the non-SLR group. The LOS was comparable in the two groups (p = 0.289). CONCLUSION This study confirms the short-term benefits of SLR by oversewing during LSG in terms of a lower incidence of 30-day morbidity, particularly bleeding, and lower rates of reoperation, with a clinically questionable longer operation time.
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Janik MR, Jędras K, Golik D, Sroczyński P. Influence of staple line reinforcement on the occurrence of bleeding complications following laparoscopic sleeve gastrectomy: a retrospective analysis. Wideochir Inne Tech Maloinwazyjne 2023; 18:665-670. [PMID: 38239579 PMCID: PMC10793147 DOI: 10.5114/wiitm.2023.133679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 11/06/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction Laparoscopic sleeve gastrectomy (LSG) has gained prominence as a therapeutic option for obesity and metabolic diseases. The choice of staple line reinforcement technique in LSG remains a subject of debate, particularly concerning postoperative bleeding complications. Aim The aim of this retrospective analysis is to assess the influence of different staple line reinforcement techniques on the occurrence of bleeding complications LSG. Material and methods We conducted a retrospective analysis of patients undergoing LSG between September 2021 and April 2023 at our institution. Patients were stratified into two groups based on the staple line reinforcement method: continuous suturing (n = 53) and clipping (n = 28). Surgical outcomes, including operative time, length of hospital stay, and bleeding complications, were assessed. Complications were classified using the Clavien-Dindo classification. Results Continuous suturing was associated with a significantly longer operative time (88.15 min vs. 74.64 min, p < 0.05) but a similar length of hospital stay. Notably, no bleeding complications occurred in the continuous suturing group, while the clipping group experienced postoperative bleeding in 7.14% of cases (p < 0.05). Continuous suturing exhibited a slightly higher incidence of minor complications classified as Class I in the Clavien-Dindo classification (7.55% vs. 0%). Conclusions This retrospective analysis suggests that continuous suturing may provide enhanced hemostasis along the staple line, reducing the risk of postoperative bleeding compared to clipping. Despite the longer operative time and a slightly higher rate of minor complications, the clinical significance of these findings should be considered within the context of individual patient risk profiles.
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Affiliation(s)
- Michal Robert Janik
- General Surgery Department, Military Institute of Aviation Medicine, Warsaw, Poland
| | - Krzysztof Jędras
- General Surgery Department, Military Institute of Aviation Medicine, Warsaw, Poland
| | - Dawid Golik
- General Surgery Department, Military Institute of Aviation Medicine, Warsaw, Poland
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10
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Yang J, Widjaja J, Wang R, Dong W, Yang D, Song H, Song Z, Gu Y. Routine gastric suspension technique in single-port sleeve gastrectomy procedure. Surg Endosc 2023; 37:9651-9657. [PMID: 37891372 DOI: 10.1007/s00464-023-10502-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/23/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Due to limited technical demand, single-port sleeve gastrectomy (SPSG) is a feasible laparoscopic technique for sleeve gastrectomy (SG). Nonetheless, difficulties exist when performing the single-port technique, and in this study, we aim to describe a slight maneuver that can improve the SPSG procedure. METHODS Patients who underwent laparoscopic SG between January 2022 and May 2023 at our hospital were included. The patients were classified into two groups: (1) SPSG and (2) multiple-port SG (MPSG). The parameters for this analysis were the patients' age, gender, weight, body mass index (BMI), conversion rate, drainage placement, 30-day readmission rate, and postoperative complications. Postoperative one-month and three-month percentages of total weight loss (%TWL) were calculated and compared. RESULTS 171 patients were included in this study: (1) the SPSG group (n = 96) and (2) the MPSG group (n = 75). No statistically significant difference was observed within the preoperative (age, gender, height, weight, and BMI) and the perioperative parameters between SPSG and MPSG (operation time, drainage placement, 30-day readmission) (p > 0.05). Per Clavien-Dindo's grading, two patients in the SPSG group suffered grade 1 complications; for the MPSG group, one patient sustained grade 2 and another suffered grade 3b complication. No statistical significance was observed on the %TWL between the two groups (p > 0.05). CONCLUSION Our study found that performing SPSG in specific patient is feasible and non-inferior when compared to the MPSG. Further studies will be needed to elucidate better the efficacy and safety of performing SPSG.
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Affiliation(s)
- Jianjun Yang
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, 200040, People's Republic of China
| | - Jason Widjaja
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, 200040, People's Republic of China
| | - Rui Wang
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, 200040, People's Republic of China
| | - Wenpei Dong
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, 200040, People's Republic of China
| | - Dongchao Yang
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, 200040, People's Republic of China
| | - Heng Song
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, 200040, People's Republic of China
| | - Zhicheng Song
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, 200040, People's Republic of China
| | - Yan Gu
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, 200040, People's Republic of China.
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Marcolin P, Machado Berleze M, Polettini J, Marchesan Rodrigues MA, Augustin Silveira D. The Impact of Helicobacter pylori on Laparoscopic Sleeve Gastrectomy Postoperative Complications: a Systematic Review and Meta-analysis. Obes Surg 2023; 33:3649-3657. [PMID: 37798512 DOI: 10.1007/s11695-023-06858-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/13/2023] [Accepted: 09/24/2023] [Indexed: 10/07/2023]
Abstract
We aimed to assess the impact of Helicobacter pylori infection on postoperative outcomes following laparoscopic sleeve gastrectomy (LSG). We searched Cochrane, Scopus, and PubMed databases, reviewed 1026 studies, and thoroughly analyzed 42 of them. Our final analysis included 13 studies comprising 6199 patients. We found that H. pylori infection was correlated with higher rates of risk of overall postoperative complications (OR 1.56; 95% CI 1.13, 2.16; P = 0.007) and staple line leak (OR 1.89; 95% CI 1.05, 3.41; P = 0.03). There were no significant differences in hospital length of stay or postoperative bleeding rates. Despite observed correlations between H. pylori positivity in gastric specimen and postoperative complications in LSG, definitive causation remains elusive, emphasizing the need for prospective randomized studies evaluating the effect of preoperative H. pylori screening and eradication.
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Affiliation(s)
- Patrícia Marcolin
- Universidade Federal da Fronteira Sul (UFFS), Rua Capitão Araújo, 20, Passo Fundo, RS, 99010121, Brazil
| | - Matheus Machado Berleze
- Universidade Federal da Fronteira Sul (UFFS), Rua Capitão Araújo, 20, Passo Fundo, RS, 99010121, Brazil.
| | - Jossimara Polettini
- Universidade Federal da Fronteira Sul (UFFS), Rua Capitão Araújo, 20, Passo Fundo, RS, 99010121, Brazil
| | - Maria A Marchesan Rodrigues
- Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Avenida Professor Mário Rubens Guimarães Montenegro, S/N, Botucatu, SP, 18618687, Brazil
| | - Daniela Augustin Silveira
- Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Avenida Professor Mário Rubens Guimarães Montenegro, S/N, Botucatu, SP, 18618687, Brazil
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Naeem Z, Volteas P, Khomutova A, Naeem A, Yang J, Nie L, Ghanem OM, Spaniolas K, Drakos P. Timing and management of bleeding after bariatric surgery. Surg Endosc 2023; 37:7437-7443. [PMID: 37400686 DOI: 10.1007/s00464-023-10201-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/11/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND The timing of bleeding after bariatric surgery and subsequent management (characterized as surgical versus non-surgical (i.e., interventions including endoscopic or interventional radiology approaches)) has not been thoroughly studied. As such, we sought to describe the rates of reoperation or non-operative intervention after bleeding following sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). METHODS The Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) database was queried between 2015 and 2018 for any bleeding after SG or RYGB and subsequent reoperation or non-operative intervention. Multivariable Fine-Gray models were used to compare the hazard of reoperation/non-operative intervention. Multivariable generalized linear regression models were used to test the number of subsequent reoperations/non-operative interventions depending on initial management. RESULTS 6251 patients with bleeding after SG or RYGB were identified, of which 2653 patients underwent subsequent procedures (n = 1375 [51.83%] RYGB index procedure, n = 1278 [48.17%] SG index procedure). 1892 (71.32%) and 761 (28.68%) patients had reoperation and non-operative intervention, respectively. For patients who developed bleeding, SG was associated with significantly higher reoperation risk, while RYGB was associated with significantly higher risk of non-operative intervention. Early bleeding was associated with significantly increased risk of reoperation and decreased risk of non-operative intervention, regardless of initial procedure. The total number of subsequent reoperations/non-operative interventions did not differ significantly depending on whether the patients had non-operative intervention or reoperation first [ratio 1.01, 95% CI (0.75, 1.36), p value 0.9418]. CONCLUSION Patients after SG who experience bleeding are more likely to undergo reoperation than RYGB patients. On the other hand, patients with bleeding after RYGB are more likely to undergo non-operative intervention compared to SG patients. Early bleeding is associated with higher risk of reoperation and lower risk of non-operative intervention both after SG and RYGB. The initial approach did not play a role in the total number of subsequent reoperations/non-operative interventions.
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Affiliation(s)
- Zaina Naeem
- Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Panagiotis Volteas
- Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Alisa Khomutova
- Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Abeer Naeem
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Jie Yang
- Department of Family, Population and Preventive Medicine, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Lizhou Nie
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Konstantinos Spaniolas
- Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Panagiotis Drakos
- Highland Hospital, Rochester University, 1000 South Avenue, Rochester, NY, 14620, USA.
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Vu AH, Chiang J, Qian Y, Tursunova N, Nha J, Ferzli G. Do all roads lead to Rome? A retrospective analysis on surgical technique in sleeve gastrectomy. Surg Endosc 2023; 37:8064-8071. [PMID: 37488445 DOI: 10.1007/s00464-023-10298-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/12/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND New York University Langone Health has three accredited bariatric centers, with 10 different bariatric surgeons. This retrospective analysis compares surgeon techniques in laparoscopic or robotic sleeve gastrectomy (SG) to identify associations with perioperative morbidity and mortality. METHODS All adults who underwent SG between 2017 and 2021 at NYU Langone Health were evaluated via EMR and MBSAQIP 30-day data. We also surveyed all 10 bariatric surgeons and compared their techniques and total adverse outcomes. Bleeding, SSI, mortality, readmission, and reoperation were specifically sub-analyzed via logistic regression. RESULTS 86 (2.77%) out of 3,104 patients who underwent SG encountered an adverse event. Lower adverse outcomes were observed with a laparoscopic approach, 40-Fr bougie, buttressing, not oversewing the staple line, using hemostatic agents, stapling 3-cm from pylorus, and no routine UGI series. Lower bleeding rates were observed in a laparoscopic approach, 40-Fr bougie, buttressing, not oversewing the staple line, using hemostatic agents, stapling 3-cm from pylorus, no routine UGI series, and not proceeding with SG if hiatal hernia is present. Lower SSI rates were observed with ViSiGi™ bougie, no hemostatic agents, and routine EGD. Lower readmission rates were observed with 40-Fr bougie, buttressing, not oversewing, and stapling 3-cm from pylorus. Hemostatic agents had higher reoperation rates. It was not feasible to test for mortality given the low incidence. CONCLUSION Certain surgical techniques in SG among our bariatric surgeons had a significant effect on the rates of adverse outcomes, bleeding, readmission, reoperation, and SSI. Our findings warrant further investigation into these techniques via multivariate regression or prospective design. LIMITATIONS This study was limited by its retrospective and univariate design. We did not account for interaction. The sample size was small, and follow-up of 30 days was relatively short. We did not include patient characteristics in the model or control for surgeon skill.
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Affiliation(s)
- Alexander Hien Vu
- Department of General Surgery, New York University Langone Health, 150 55th Street, Brooklyn, NY, 11220, USA.
| | - Jessica Chiang
- Department of General Surgery, New York University Langone Health, 150 55th Street, Brooklyn, NY, 11220, USA
| | - Yunzhi Qian
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Nilufar Tursunova
- Department of General Surgery, New York University Langone Health, 150 55th Street, Brooklyn, NY, 11220, USA
| | - Jaein Nha
- Department of General Surgery, New York University Langone Health, 150 55th Street, Brooklyn, NY, 11220, USA
| | - George Ferzli
- Department of General Surgery, New York University Langone Health, 150 55th Street, Brooklyn, NY, 11220, USA.
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Vosburg RW. Factors Related to Bleeding and Leak Rates After Robotic Sleeve Gastrectomy. Obes Surg 2023; 33:2658-2661. [PMID: 37434019 DOI: 10.1007/s11695-023-06712-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Robotic sleeve gastrectomy has been increasing in annual incidence in recent years. Although rare, post op bleeding and leak in these cases can lead to significant morbidity, mortality, and healthcare utilization. OBJECTIVES To determine preop comorbidity risk factors and operative techniques associated with risk of bleeding or leak within 30 days of robotic sleeve gastrectomy. METHODS The MBSAQIP database was analyzed. A total of 53,548 RSG cases were included in analysis. Surgeries took place from accredited centers in the USA from 2015 to 2019. CONCLUSIONS Preoperative anticoagulation, renal failure, COPD, and OSA were found to increase in the risk for transfusion requirements after SG. Receiving a transfusion and smoking increased the risk for leak. Staple line reinforcement significantly decreased transfusion and leak rates. Staple line oversewing did not have an impact on bleeding or leak.
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Affiliation(s)
- R Wesley Vosburg
- Department of Surgery, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, 02138, USA.
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Cesana G, Fermi F, Andreasi V, Bonaldi M, Uccelli M, Oldani A, Zanoni A, Olmi S. Could Glycated Hemoglobin be Leakage Predictor in Sleeve Gastrectomy? A Retrospective Observational Study on 4233 Patients. Obes Surg 2023; 33:2851-2858. [PMID: 37468702 DOI: 10.1007/s11695-023-06754-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/07/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE Diabetes increases the risks related to surgery. At the same time, bariatric surgery improves diabetes. Glycated hemoglobin (A1C) is an index of diabetes severity. The purpose of this study is to evaluate A1C as a possible predictor of postoperative complications after Sleeve Gastrectomy (SG), focusing on leakage. MATERIALS AND METHODS Monocentric retrospective study considering all consecutive patients with obesity, with or without diabetes, who underwent bariatric surgical procedures, from January 2018 to December 2021. All patients had preoperative A1C values. RESULTS 4233 patients were considered. 522 patients (12.33%) were diabetics (A1C ≥ 6.5%). Of these, 260 patients (6.14%) had A1C ≥ 7% and 59 (1.39%) A1C ≥ 8%. 1718 patients (40.58%) were in a pre-diabetic range (A1C 5.7%-6.5%). Higher A1C values were associated with older age, male gender, higher BMI and increased rate of comorbidities. A longer operative time was observed for patients with A1C ≥ 7%, p = 0.027 (53 ± 20 vs 51 ± 18 min). The frequency of leakage was significantly higher when A1C ≥ 7% (3.8% vs 2.0%, p = 0.026). The frequency of leakage further increased when A1C ≥ 8% (5.1%), although this difference did not reach statistical significance. CONCLUSION Patients with obesity and A1C ≥ 7% need to be referred to a diabetologist to treat diabetes before surgery and consequently decrease the risk of leakage.
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Affiliation(s)
- Giovanni Cesana
- Department of General Surgery, Centre of Excellence S.I.C.Ob (Italian Society in Obesity Surgery), Zingonia, BG, Italy.
| | - Francesca Fermi
- Department of General Surgery, Centre of Excellence S.I.C.Ob (Italian Society in Obesity Surgery), Zingonia, BG, Italy
- Olmi is an Associated Professor. Fermi and Andreasi are Residents in the General Surgery Program, Università Vita-Salute San Raffaele, Milan, Italy
| | - Valentina Andreasi
- Department of General Surgery, Centre of Excellence S.I.C.Ob (Italian Society in Obesity Surgery), Zingonia, BG, Italy
- Olmi is an Associated Professor. Fermi and Andreasi are Residents in the General Surgery Program, Università Vita-Salute San Raffaele, Milan, Italy
| | - Marta Bonaldi
- Department of General Surgery, Centre of Excellence S.I.C.Ob (Italian Society in Obesity Surgery), Zingonia, BG, Italy
| | - Matteo Uccelli
- Department of General Surgery, Centre of Excellence S.I.C.Ob (Italian Society in Obesity Surgery), Zingonia, BG, Italy
| | - Alberto Oldani
- Department of General Surgery, Centre of Excellence S.I.C.Ob (Italian Society in Obesity Surgery), Zingonia, BG, Italy
| | - Adelinda Zanoni
- Department of General Surgery, Centre of Excellence S.I.C.Ob (Italian Society in Obesity Surgery), Zingonia, BG, Italy
| | - Stefano Olmi
- Department of General Surgery, Centre of Excellence S.I.C.Ob (Italian Society in Obesity Surgery), Zingonia, BG, Italy
- Olmi is an Associated Professor. Fermi and Andreasi are Residents in the General Surgery Program, Università Vita-Salute San Raffaele, Milan, Italy
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Sewefy AM, Sabry K, Hetta HM, Atyia AM. The Impact of Blood Pressure Switching (from Controlled Hypotension to Late Elevated Blood Pressure) During Laparoscopic Sleeve Gastrectomy: Controlled Clinical Trial. Obes Surg 2023; 33:2602-2607. [PMID: 37351766 DOI: 10.1007/s11695-023-06699-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/10/2023] [Accepted: 06/16/2023] [Indexed: 06/24/2023]
Abstract
PURPOSE Laparoscopic sleeve gastrectomy (LSG) is the most done bariatric procedure. Bleeding and leak are the most common associated complications. Elevation of systolic blood pressure (SBP) leads to discovering the bleeding sites but results in a bloody field and increases the operative time. Controlled hypotension shortens the operative time, reduces tissue edema, and improves field vision. We aimed to test controlled hypotension during LSG. MATERIAL AND METHODS This was a randomized controlled trial that included 200 patients who were operated by LSG, randomly assigned to 2 equal groups: group 1, operated with controlled hypotensive anesthesia, and group 2, operated with elevated SBP to 140 mmHg. RESULTS Of the patients, 162 (81%) were females, and 38 (19%) were male. The mean BMI was 45.7 kg/m2. The mean age was 41.7 years. The operative time was 36.43 ± 6.73 min in group 1 vs. 44.71 ± 5.47 min in group 2. The mean of total number of used gauzes and clips was 2.70 ± 3.49 in group 1 vs. 8.83 ± 3.15 in group 2. The mean amount of drain output was 37.65 ± 21.90 ml in group 1 vs. 74.00 ± 16.54 ml in group 2. The mean drop in the postoperative hematocrit was 0.08 in group 1 vs. 0.22 in group 2. The incidence of postoperative bleeding was 0% in group 1 vs. 1% in group 2. CONCLUSIONS Controlled hypotensive anesthesia in LSG reduces the operative time, reduces the intraoperative bleeding, and improves the operative field.
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Affiliation(s)
- Alaa M Sewefy
- Department of Surgery, Minia University Hospital, Minia, Egypt.
| | - Karim Sabry
- Faculty of Medicine, Ain Shams University, Ain Shams, Egypt
| | - Hassan M Hetta
- Department of Anesthesia, Minia University Hospital, Minia, Egypt
| | - Ahmed M Atyia
- Department of Surgery, Minia University Hospital, Minia, Egypt
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17
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Sala DT, Fodor SR, Voidăzan S, Tilinca MC, Gomotîrceanu AM, Puiac IC, Ciorba MI, Moriczi R, Kiss BI, Ion RM, Calin C, Neagoe RM. Oversewing and Gastropexy in Laparoscopic Sleeve Gastrectomy - Two Futile Steps of the Procedure? An Observational Case-Control Study. Obes Surg 2023; 33:2420-2427. [PMID: 37351763 DOI: 10.1007/s11695-023-06681-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/03/2023] [Accepted: 06/08/2023] [Indexed: 06/24/2023]
Abstract
PURPOSE Laparoscopic sleeve gastrectomy (LSG) is the most popular primary bariatric metabolic procedure worldwide but severe complications are still reported, and there is no ideal technique to avoid them. This study analyses the impact of oversewing (OS) and gastropexy (GP) on complication rate, early dyspeptic and late de novo GERD symptoms after LSG. MATERIAL AND METHOD A case-control study was conducted on patients with obesity who underwent LSG. The total cohort was divided in group A (control group) - patients with no oversewing (OS) or gastropexy (GP), group B - patients with OS but no gastropexy and group C - patients with both OS and GP performed during LSG. RESULTS We included 272 patients with obesity with a mean BMI 42.9±6.94 kg/m2, 96 patients in group A, 90 patients in group B and 86 in group C with no statistical differences between them. We had 5 cases of postoperative hemorrhage (4 in group A) and three patients who developed leaks (2 in group A and one in group B). Prolonged and severe early dyspeptic episodes and after 6 months reflux symptoms were significantly more in groups A and B (p<0.05). The operative time was longer in group B and C (p<0.05) but with no difference in procedure -related morbidity and in hospital length of stay. CONCLUSION Adding both OS and GP to LSG reduce complications rate with no influence on procedure-related postoperative morbidity and in-hospital length of stay. GP reduces early postoperative dyspeptic and de novo GERD symptoms after LSG.
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Affiliation(s)
- Daniela T Sala
- Second Department of Surgery, University of Medicine, Pharmacy, Science and Technology "George Emil Palade" of Târgu Mures, County Emergency Clinical Hospital of Târgu Mureş, 540109, Târgu Mureș, Romania
| | - Stefania R Fodor
- University of Medicine, Pharmacy, Science and Technology "George Emil Palade" of Târgu Mures, Anaesthesiology and Intensive Care Clinic, County Emergency Clinical Hospital of Târgu Mureş, 540109, Târgu Mureș, Romania.
| | - Septimiu Voidăzan
- Second Department of Surgery, University of Medicine, Pharmacy, Science and Technology "George Emil Palade" of Târgu Mures, County Emergency Clinical Hospital of Târgu Mureş, 540109, Târgu Mureș, Romania
| | - Mariana C Tilinca
- Second Department of Surgery, University of Medicine, Pharmacy, Science and Technology "George Emil Palade" of Târgu Mures, County Emergency Clinical Hospital of Târgu Mureş, 540109, Târgu Mureș, Romania
| | - Adriana M Gomotîrceanu
- University of Târgu Mureș, TopMed Medical Center, Internal Medicine Department, Târgu Mureș, 540156, Târgu Mureș, Romania
| | - Ion C Puiac
- University of Medicine, Pharmacy, Science and Technology "George Emil Palade" of Târgu Mures, Anaesthesiology and Intensive Care Clinic, County Emergency Clinical Hospital of Târgu Mureş, 540109, Târgu Mureș, Romania
| | - Marius I Ciorba
- University of Medicine, Pharmacy, Science and Technology "George Emil Palade" of Târgu Mures, Gastroenterology Clinic, County Emergency Clinical Hospital of Târgu Mureş, 540109, Târgu Mureș, Romania
| | - Renata Moriczi
- Second Department of Surgery, County Emergency Clinical Hospital of Târgu Mureş, 540109, Târgu Mureș, Romania
| | - Botond I Kiss
- Second Department of Surgery, County Emergency Clinical Hospital of Târgu Mureş, 540109, Târgu Mureș, Romania
| | - Razvan M Ion
- Second Department of Surgery, University of Medicine, Pharmacy, Science and Technology "George Emil Palade" of Târgu Mures, County Emergency Clinical Hospital of Târgu Mureş, 540109, Târgu Mureș, Romania
| | - Constantin Calin
- Second Department of Surgery, County Emergency Clinical Hospital of Târgu Mureş, 540109, Târgu Mureș, Romania
| | - Radu Mircea Neagoe
- Second Department of Surgery, University of Medicine, Pharmacy, Science and Technology "George Emil Palade" of Târgu Mures, County Emergency Clinical Hospital of Târgu Mureş, 540109, Târgu Mureș, Romania
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Zarzycki P, Rymarowicz J, Małczak P, Pisarska-Adamczyk M, Mulek R, Binda A, Dowgiałło-Gornowicz N, Major P. Differences in Technical Aspects of Primary Sleeve Gastrectomy Prior to Redo Bariatric Surgery-A Multicenter Cohort Study (PROSS Study). MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040799. [PMID: 37109757 PMCID: PMC10146411 DOI: 10.3390/medicina59040799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/16/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: Although the technical simplicity of laparoscopic sleeve gastrectomy is relatively well understood, many parts of the procedure differ according to bariatric surgeons. These technical variations may impact postoperative weight loss or the treatment of comorbidities and lead to qualification for redo procedures. Materials and Methods: A multicenter, observational, retrospective study was conducted among patients undergoing revision procedures. Patients were divided into three groups based on the indications for revisional surgery (insufficient weight loss or obesity-related comorbidities treatment, weight regain and development of complications). Results: The median bougie size was 36 (32-40) with significant difference (p = 0.04). In 246 (51.57%) patients, the resection part of sleeve gastrectomy was started 4 cm from the pylorus without significant difference (p = 0.065). The number of stapler cartridges used during the SG procedure was six staplers in group C (p = 0.529). The number of procedures in which the staple line was reinforced was the highest in group A (29.63%) with a significant difference (0.002). Cruroplasty was performed in 13 patients (p = 0.549). Conclusions: There were no differences between indications to redo surgery in terms of primary surgery parameters such as the number of staplers used or the length from the pylorus to begin resection. The bougie size was smaller in the group of patients with weight regain. Patients who had revision for insufficient weight loss were significantly more likely to have had their staple line oversewn. A potential cause could be a difference in the size of the removed portion of the stomach, but it is difficult to draw unequivocal conclusions within the limitations of our study.
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Affiliation(s)
- Piotr Zarzycki
- Department of Medical Education, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Justyna Rymarowicz
- 2nd Department of General Surgery, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Piotr Małczak
- 2nd Department of General Surgery, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | | | - Rafał Mulek
- EuroMediCare Specialist Hospital and Clinic, 54-144 Wroclaw, Poland
| | - Artur Binda
- Department of General, Oncological and Digestive Tract Surgery, Centre of Postgraduate Medical Education, Orłowski Hospital, 00-416 Warsaw, Poland
| | - Natalia Dowgiałło-Gornowicz
- Department of General, Minimally Invasive and Elderly Surgery, Collegium Medicum, University of Warmia and Mazury, 10-045 Olsztyn, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, 30-688 Krakow, Poland
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19
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From Our One Anastomosis Gastric Bypass (OAGB) Experience to Establishing Single Anastomosis Sleeve Ileal (SASI) Bypass Procedure: A Single-Center Report. Obes Surg 2023; 33:1318-1322. [PMID: 36810810 DOI: 10.1007/s11695-023-06523-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/11/2023] [Accepted: 02/15/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Bariatric surgery has been proven to be the most effective treatment for obesity with or without metabolic syndrome. One anastomosis gastric bypass (OAGB) is a well-established bariatric procedure developed over the past 20 years with excellent outcomes. Single anastomosis sleeve ileal (SASI) bypass is introduced as a novel bariatric and metabolic procedure. There is some similarity between these two operations. This study aimed to present our SASI procedure based on the past experience of the OAGB in our center. METHOD Thirty patients with obesity underwent SASI surgery from March 2021 to June 2022. Herein, we demonstrated our techniques step by step and key points of techniques learned from our experience with OAGB (shown in the video) with satisfying surgical outcomes. The clinical characteristics, peri-operative variables, and short-term outcomes were reviewed. RESULTS There was no case of conversion to open surgery. The mean operative time, volume of blood loss, and hospital stay were 135.2 ± 39.2 min, 16.5 ± 6.2 mL, and 3.6 ± 0.8 days, respectively. There is no postoperative leakage, bleeding, or mortality. The percentage of total weight loss and excess weight loss at 6 months were 31.2 ± 6.5 and 75.3 ± 14.9, respectively. Improvement in type 2 diabetes (11/11, 100%), hypertension (14/26, 53.8%), dyslipidemia (16/21, 76.2%), and obstructive sleep apnea (9/11, 81.8%) were observed at 6 months after surgery. CONCLUSION Our experience showed that our proposed SASI technique is feasible and may help surgeons perform this promising bariatric procedure without encountering many obstacles.
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20
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Eckharter C, Heeren N, Mongelli F, Sykora M, Mühlhäusser J, Lottenbach N, Scheiwiller A, Metzger J, Gass JM. Partial staple line reinforcement with synthetic buttressing material in laparoscopic sleeve gastrectomy: a propensity score-matched analysis. Langenbecks Arch Surg 2023; 408:47. [PMID: 36662323 PMCID: PMC9859840 DOI: 10.1007/s00423-023-02796-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/22/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE Staple line leakage (SLL) and staple line bleeding (SLB) are the most relevant postoperative complications of sleeve gastrectomy (SG). It is controversial whether and which method of staple line reinforcement (SLR) can best reduce these complications. The primary objective of this study was to investigate whether reinforcement of the most proximal part of the staple line with synthetic buttressing material, a strategy we termed partial SLR (p-SLR), reduces the 30-day incidence of SLL. METHODS A retrospective search of medical records of all bariatric patients from 2010 to 2019 was performed. Patients who underwent SG with either p-SLR or non-SLR were included. Intraoperative and postoperative outcomes were analyzed before and after propensity score matching (PSM). RESULTS Data from 431 patients were analyzed (364 in the p-SLR group and 67 in the non-SLR group). No difference in the 30-day incidence of SLL was observed between the two groups. The 30-day incidence of SLB (1.1% vs. 6.0% in the p-SLR and non-SLR groups, respectively) was significantly lower in the p-SLR group. These results were confirmed by PSM analysis. CONCLUSION Partial staple line reinforcement with synthetic buttressing material does not reduce the 30-day incidence of SLL. Although our analysis showed a significant reduction in the 30-day incidence of SLB in the p-SLR group, this result should be interpreted with caution.
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Affiliation(s)
- Christoph Eckharter
- Department of General and Visceral Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Nickolaus Heeren
- Department of General and Visceral Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | | | - Martin Sykora
- Department of General and Visceral Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Department of Surgery, Nidwalden Hospital, Stans, Switzerland
| | - Julia Mühlhäusser
- Department of General and Visceral Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Nathalie Lottenbach
- Department of General and Visceral Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Andreas Scheiwiller
- Department of General and Visceral Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Jürg Metzger
- Department of General and Visceral Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Jörn-Markus Gass
- Department of General and Visceral Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
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Abbas M, Seleem A, Khalaf AM, Ibrahim EA, Adwi M, Hasan A. Role of Staple Line Reinforcement by Oversewing in Preventing Leakage and Bleeding after Sleeve Gastrectomy. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Staple line (SL) bleeding and leakage after laparoscopic sleeve gastrectomy (LSG) are still commonly challenging complications. Some surgeons use SL reinforcement (SLR) to decrease the rate of bleeding and leakage, by different methods such as oversewing, fibrin glue, and bovine pericardium, but their role in preventing complications is still controversial.
AIM: The aim of this study is to evaluate the incidence of SL bleeding and leakage after LSG by oversewing SL using V-Loc suture material.
METHODS: This is a retrospective study carried out on 200 consecutive patients with (body mass index [BMI] >40 kg/m2) or (>35 kg/m2 plus comorbid diseases associated with obesity), divided into two groups according to SLR. Study participants were divided into two equal groups, each one included 100 patients; Group A underwent LSG without SLR, and Group B underwent LSG with SLR.
RESULTS: Post-operative SL bleeding was 4% in Group A and 2% in Group B (p = 0.315). Bleeding control by reoperation was 4% in Group A and 0% in Group B (p = 0.021). Just two patients had leakage in Group A (2%) and were managed with endoscopic stenting (p = 0.105). Operative time was shorter in Group A than in Group B, with a mean of 80 and 91.41 min, respectively (p < 0.001).
CONCLUSION: SLR with V-Loc suture was not effective in reducing the incidence of post-operative bleeding or leakage. However, it has a positive effect on reducing the incidence of reoperation, despite the prolongation of operative time. There is a need for more studies including larger samples to investigate the effectiveness in reducing the post-operative complications of sleeve gastrectomy operation; therefore, more prospective studies on a wide population are advised to ensure the effectiveness of reinforcement of stale line in the prevention of sleeve gastrectomy complications.
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