The Use of Intraoperative Endoscopy May Decrease Postoperative Stenosis in Laparoscopic Sleeve Gastrectomy

Area of Science:

• Bariatric Surgery
• Gastrointestinal Endoscopy
• Surgical Complications

Background:

• Laparoscopic sleeve gastrectomy (LSG) is a prevalent bariatric procedure globally.
• Leaks and stenosis are significant complications following LSG, leading to increased patient morbidity.
• Evaluating the impact of intraoperative endoscopy (IOE) on these complications is crucial.

Purpose of the Study:

• To assess the effectiveness of routine intraoperative endoscopy (IOE) in reducing leak and stenosis rates after laparoscopic sleeve gastrectomy (LSG).
• To determine if IOE can alter surgical strategy to prevent or manage complications during LSG.

Main Methods:

• A retrospective review of 310 laparoscopic sleeve gastrectomy (LSG) cases performed between 2009 and 2015.
• Intraoperative endoscopy (IOE) was performed using a 32 Fr endoscope after greater curvature dissection.
• Stenosis identified during IOE led to suture removal and repeat endoscopy.

Main Results:

• The overall clinical leak rate was 0.3% (1/310), with 0% in primary LSG and 12.5% in revisional cases.
• Intraoperative endoscopy (IOE) detected stenosis in 3.2% (10/310) of cases, which resolved after suture adjustment.
• No clinical stenosis was observed post-LSG in this cohort.

Conclusions:

• Routine intraoperative endoscopy (IOE) appears to be a valuable tool in managing laparoscopic sleeve gastrectomy (LSG).
• The use of IOE may contribute to the low rates of leak and stenosis observed in this series.
• IOE can guide intraoperative adjustments, potentially improving surgical outcomes.