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Impact of the Surgical Experience on Leak Rate After Laparoscopic Sleeve Gastrectomy
Patrick Noel1, Marius Nedelcu2, Michel Gagner3
1Hôpital Prive La Casamance, Aubagne, France.
Introduction:
Laparoscopic sleeve gastrectomy (LSG) has become one of the most commonly performed bariatric procedures, largely due to several advantages it carries over more complex bariatric procedures. LSG is generally considered a straightforward procedure, but one of the major concerns is a staple line leak.
Objective:
The objectives of this study are to evaluate the correlation between surgeon's experience and leak rate and to assess the different risk factors for developing a gastric leak after LSG.
Setting:
Private hospital, France.
Methods:
The analysis of a single surgeon's yearly leak rate since the introduction of LSG for possible risk factors was done.
Results:
A total of 2012 LSGs were performed in between September, 2005 and December, 2014. Twenty cases (1 %) of gastric leak were recorded. Of these, 17 patients were women (94.4 %) with a mean age of 39.4 years (range 22-61) and mean body mass index (BMI) 41.2 kg/m(2) (range 34.8-57.1). On a yearly basis, the leak rate was 4.8 % (2006), 5.7 % (2007), 0 (2008), 2.6 % (2009), 2 % (2010), 0.8 % (2011), 0.6 % (2012), 0.2 % (2013), and 0 (2014). In the first 1000 cases (group A), there were 18 cases of gastric leak and in the last 1000 cases, there were 800 with GORE® SEAMGUARD® Bioabsorbable Staple Line Reinforcement (group B) 2 cases of gastric leak (p = 0.009). A revisional LSG, 395 patients after gastric banding and 61 patients re-sleeve gastrectomy, was performed in 456 cases (22.7 %). There were 3 cases of leak (0.65 %). There were two deaths.
Conclusion:
LSG can be performed with a low complication rate. This large series of a single surgeon's experience demonstrated that the leak rate after LSG could be significantly decreased over time with changes in techniques.
