Laparoscopic Reinforced Sleeve Gastrectomy: Early Results and Complications

Background Sleeve gastrectomy (SG) was pioneered as a twostage intervention for super and super-super obesity to minimize morbidity and mortality; it is employed increasingly as a primary procedure. Early outcomes and integrity of laparoscopic SG (LSG) against leak using a technique incorporating gastric transection-line reinforcement were studied. Methods Between 2003 and 2009, 121 patients underwent LSG (16, two-stage; 105, primary). Of the patients, 66% were women, mean age 38.8±10.9 (15.0–64.0), and body mass index (BMI, kg/m2) 48.7±9.3 (33.7–74.8). Bovine pericardium (Peri-Strips Dry [PSD]) was used to reinforce the staple line. Parametric and nonparametric tests were used, as appropriate. The paired t test was used to assess change from baseline; bivariate analyses and logistic regression were used to identify preoperative patient characteristics predictive of suboptimal weight loss. Results Mean operative time was 105 min (95–180), and mean hospitalization was 5.6 days (1–14). There was no mortality. Therewere 6 (5.0%) complications: 1 intraoperative leak, 1 stricture, 1 trocar-site bleed, 1 renal failure, and 2 wound infections. There were no postoperative staple-line leaks. Following 15 concomitant hiatal hernia operations, 3 (20%) recurred: 1 revised to RYGB and 2 in standby. Two post-LSG hiatal hernias of the two-stage series required revisions because of symptoms. BMI decreased 24.7% at 6 months (n=55) to 37.5±9.3 (22.2–58.1); %EWL was 48.1 ±19.3 (15.5–98.9). Twelve-month BMI (n=41) was 38.4± 10.5 (19.3–62.3); %EWL was 51.7±25.0 (8.9–123.3). Fortyeight- month BMI (n=13) was 35.6±6.8 (24.9–47.5); %EWL was 61.1±12.2 (43.9–82.1) (p<0.001). Preoperative BMI was predictive of >70% of patients who experienced <50% EWL at 6 months. At 2 weeks, 100% of type 2 diabetes patients (n=23) were off medication (mean HbA1C, 5.9± 0.5%; glycemia, 90.0±19.9 mg/dL (p<0.01) at 3 months). Conclusions Laparoscopic PSD-reinforced LSG as a staged or definitive procedure is safe and effective in the short term and provides rapid type 2 diabetes mellitus reduction with a very low rate of complications.