Assessment of Sleeve Gastrectomy Surgical Technique: First Look at 30-Day Outcomes Based on the MBSAQIP Database

Obesity rates in the US have reached epidemic proportions, and sleeve gastrectomy (SG) is the procedure performed most commonly. Controversies exist about the most appropriate surgical technique.

Using the 2016 MBSAQIP database, we selected all primary SG procedures and compared 4 surgical techniques (staple line reinforcement [SLR] alone; SLR and oversewing [OS]; no SLR or OS; and OS alone). Primary outcomes were bleeding and organ space infection (OSI), including leakage. Secondary outcomes were 30-day severe adverse events (SAEs) and readmissions. We conducted separate chi-square tests of association, followed by 4 separate exploratory multivariable logistic regression models.

There were significant differences in bleeding (p = 0.002) and SAE rates (p = 0.003) among the 4 SG techniques; both SLR and OS yielded lower bleeding and SAE rates compared with the other techniques (0.3% and 1.9%, respectively). The associations between SG technique and OSI (p = 0.93) and readmission (p = 0.24) were not significant. The following SG techniques independently predicted less likelihood of bleeding: SLR alone (adjusted odds ratio [AOR] 0.70; 95% CI 0.54 to 0.90; p = 0.006) and both SLR and OS (AOR 0.50; 95% CI 0.33 to 0.77; p = 0.002). In addition, SLR and OS independently predicted less likelihood of SAEs (AOR 0.76; 95% CI 0.64 to 0.91; p = 0.003).

Our study demonstrated that SLR resulted in lower postoperative bleeding rates, but not lower leak rates. When combined with OS, SLR yielded lower 30-day SAE rates. Future studies must clarify and confirm these results.