Evaluating the effect of operative technique on leaks after laparoscopic sleeve gastrectomy: a case-control study
Varban OA, Sheetz KH, Cassidy RB, Stricklen A, Carlin AM, Dimick JB, and Finks JF. Evaluating the effect of operative technique on leaks after laparoscopic sleeve gastrectomy: a case-control study. Surg Obes Relat Dis 2017; 13(4):560-567.
Surg Obes Relat Dis
OBJECTIVE: To assess the effect of operative technique on staple line leaks after laparoscopic sleeve gastrectomy (LSG).
BACKGROUND: Staple-line leaks after LSG are a major source of morbidity and mortality. Variations in operative technique exist; however, their effect on leaks is poorly understood.
METHODS: We analyzed data from the Michigan Bariatric Surgery Collaborative (MBSC) to perform a case-control study comparing patients who had a clinically significant leak after undergoing a primary LSG to those who did not. A total of 45 patients with leaks were identified between January 2007 and December 2013. The leak group was matched 1:2 to a control group based on procedure type, age, body mass index, sex, and year the procedure was performed. Technique-specific factors were assessed by reviewing operative notes from all primary bariatric procedures in our study population. Conditional logistic regression was used to identify techniques associated with leaks. To increase the power of our analysis, we used a significance level of .10.
RESULTS: Leak rates with LSG have decreased over the past 5 years (1.18% to .36%) as annual case volume has increased (846 cases/yr to 4435 cases/yr). Surgeons who performed 43 or more cases per year had a leak rate
CONCLUSION: Despite considerable variation in operative technique, leak rates with laparoscopic sleeve gastrectomy have decreased over time as operative volume has increased. Oversewing of the staple line was associated with fewer leaks, but specific suturing technique was not uniform and oversewing was performed routinely by more experienced surgeons with higher case volumes and less complication rates overall. Before standardizing surgical technique one must take into account variations in surgeon skill and experience.
Medical Subject Headings
Anastomotic Leak; Case-Control Studies; Female; Follow-Up Studies; Gastrectomy; Humans; Laparoscopy; Male; Michigan; Middle Aged; Morbidity; Obesity, Morbid; Operative Time; Prospective Studies; Reoperation; Suture Techniques; Sutures; Time Factors