Role of staple line fixation during laparoscopic sleeve gastrectomy
DOI:
https://doi.org/10.18203/2349-2902.isj20175887Keywords:
Axial rotation, Fixation, Gastric emptying, Sleeve gastrectomy, VomitingAbstract
Background: Although sleeve gastrectomy provides a technically simple procedure with minimal effect on digestive tract it deprives the stomach of its ligaments of fixation which results in impairment of gastric functions, vomiting, axial gastric rotation in addition to bleeding or leakage from the stable line. Objective of present study is the effect of stable line fixation during sleeve gastrectomy.
Methods: This is a prospective randomized study using closed envelop method carried on 100 patients with morbid obesity who underwent laparoscopic sleeve gastrectomy (LSG) they were divided into two groups each is 50 patient group A underwent classic (LSG) with no fixation and group (B) with staple line fixation.
Results: Patients were 68 females and 32 males with a mean age of 32.2±5.7 years, mean (BMI) 48.9±8.6kg/m2. postoperative vomiting, gastric axial rotation, impaired gastric emptying all were significantly higher in group A. Although both staple line bleeding and leakage were higher in the group A, but it was not statistically significant. Also, the operative time was shorter in the group A, but it was not significant.
Conclusions: staple line fixation should be a step during sleeve gastrectomy as it regains the stomach its ligaments of fixation anatomically and so functions better less vomiting, less gastric axial rotation, better gastric emptying in addition to decreasing staple line bleeding and leakage with minimal effect on operative time.
References
Frezza EE. Laparoscopic vertical sleeve gastrectomy for morbid obesity. The future procedure of choice. Surg Today. 2007;37(4):275-81.
Rosenthal RJ, Panel IS. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8(1):8-19.
Trelles NG, Michel. Updated Review of Sleeve Gastrectomy. Open Gastr J. 2008;2:41-9.
Gumbs AA, Gagner M, Dakin G, Pomp A. Sleeve gastrectomy for morbid obesity. Obes Surg. 2007;17:962-9.
Keidar A, Appelbaum L, Schweiger C, Elazary R, Baltasar A. Dilated upper sleeve can be associated with severe postoperative gastroesophageal dysmotility and reflux. Obes Surg. 2010;20:140-7.
Carter PR, LeBlanc KA, Hausmann MG, Kleinpeter KP, Jones SM. Association between gastroesophageal reflux disease and laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2011;7(5):569-72.
Chiu S, Birch DW, Shi X, Sharma AM, Karmali S. Effect of sleeve gastrectomy on gastroesophageal reflux disease: a systematic review. Surg Obes Relat Dis. 2011;7:510-15.
Howard DD, Caban AM, Cendan JC, Ben-David K. Gastroesophageal reflux after sleeve gastrectomy in morbidly obese patients. Surg Obes Relat Dis. 2011;7:709-13.
Parikh A, Alley JB, Peterson RM, Harnisch MC, Pfluke JM, Tapper DM, et al. Management options for symptomatic stenosis after laparoscopic vertical sleeve gastrectomy in the morbidly obese. Surg Endosc. 2012;26:738-46.
Agha RA, Borrelli MR, Vella-Baldacchino M, Thavayogan R, Orgill DP. The STROCSS Statement: Strengthening the Reporting of Cohort Studies in Surgery. Int J Surg. 2017.
Fried M, Hainer V, Basdevant A, Buchwald H, Deitel M, Finer N, et al. Inter-disciplinary European guidelines on surgery of severe obesity. Int J obes. 2007;31(4):569-77.
Initiative NO. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. National Institutes of Health. 1998:98-4083.
Sarkhosh K, Birch DW, Sharma A, Karmali S. Complications associated with laparoscopic sleeve gastrectomy for morbid obesity: a surgeon’s guide. Can J Surg. 2013;56(5):347-52.
Han SM, Kim WW, Oh JH. Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obes surg. 2005;15(10):1469-75.
Abou Rached A, Basile M, El Masri H. Gastric leaks post sleeve gastrectomy: a review of its prevention and management. World J Gastroenterol. 2014;20(38):13904-10.
Baumann T, Kuesters S, Grueneberger J, Marjanovic G, Zimmermann L, Schaefer AO, et al. Time-resolved MRI after ingestion of liquids reveals motility changes after laparoscopic sleeve gastrectomy--preliminary results. Obes Surg. 2011;21(1):95-101.
Subhas G, Gupta A, Sabir M, Mittal VK. Gastric remnant twist in the immediate post-operative period following laparoscopic sleeve gastrectomy. World J Gastr surg. 2015;7(11):345.
Melissas J, Koukouraki S, Askoxylakis J, Stathaki M, Daskalakis M, Perisinakis K, et al. Sleeve gastrectomy: a restrictive procedure? Obes Surg. 2007;17(1):57-62.
Carbone SF, Di Cosmo L, Tirone A, Bancheri A, Vuolo G, Volterrani L. Evaluation of motility changes after laparoscopic sleeve gastrectomy using magnetic resonance imaging. Obes Surg. 2011;21(11):1806-7.
Sevcik WE, Steiner IP. Acute gastric volvulus: case report and review of the literature. CJEM. 1999;1(3):200-3.
Wastell C, Ellis H. Volvulus of the stomach. A review with a report of 8 cases. Br J Surg. 1971;58(8):557-62.
Santoro S. Technical aspects in sleeve gastrectomy. Obes Surg. 2007;17(11):1534-5.
Afaneh C, Costa R, Pomp A, Dakin G. A prospective randomized controlled trial assessing the efficacy of omentopexy during laparoscopic sleeve gastrectomy in reducing postoperative gastrointestinal symptoms. Surg Endosc. 2015;29 (1):41-7.
Godoy E, Coelho D. Gastric sleeve fixation strategy in laparoscopic vertical sleeve gastrectomy. ABCD Arq Bras Cir Dig. 2013;26:79-82.
Jossart GH. Food Intolerance in the Sleeve Patient: Prevention, Evaluation, and Management. In Bariatric Surg Compl Emerg. 2016:173-180.
Murcia CH, Quintero PG, Rabaza J, Gonzalez A. Laparoscopic management of gastric torsion after sleeve gastrectomy. CRSLS. e2014-00143.
Chang PC, Tai CM, Hsin MC, Hung CM, Huang IY, Huang CK. Surgical standardization to prevent gastric stenosis after laparoscopic sleeve gastrectomy: a case series. Surg Obes Relat Dis. 2017;13(3):385-90.
Himpens J, Dapri G, Cadiere GB. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg. 2006;16:1450-6.
Hamoui N, Anthone G, Kaufman H, Crookes PF. Sleeve Gastrectomy in high-risk patients. Obes Surg. 2006;16:1445-9.
Goitein D, Goitein O, Feigin A, Zippel D, Papa M. Sleeve gastrectomy: radiographic patterns after surgery. Surg Endosc. 2009;23:1559-63.
Dhahri A, Verhaeghe P, Hajji H, Fuks D, Badaoui R, Deguines JB, et al. Sleeve gastrectomy: technique and results. J Visc Surg. 2010;147:e39-46.
