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Exploring alternative techniques for laparoscopic sleeve gastrectomy with stapling first: the in situ method in a
Dongjae Jeon1, Yoona Chung2, Bomina Paik2
1Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Purpose:
Laparoscopic sleeve gastrectomy (LSG) is the most common metabolic and bariatric surgery worldwide. However, achieving adequate exposure at the angle of His remains technically challenging. This study introduces a modified "in situ" method, hypothesizing shorter operative time without increased complications or compromised 1-year weight loss.
Methods:
This retrospective analysis included primary LSG (in situ or conventional method) performed between July 2019 and January 2022. Propensity score matching was applied to address sample size imbalance and ensure comparability. Perioperative outcomes, operative time, and 1-year weight loss of the 2 groups were compared.
Results:
A total of 717 LSG cases were included. After propensity score matching, 147 in situ and 49 conventional cases were analyzed and groups were well balanced. In the in situ group, 2 patients (1.4%) experienced major complications (3 events: 2 bleedings, 1 leakage), whereas none occurred in the conventional group. Mean operative time was significantly shorter with the in situ method (75.9 ± 15.4 minutes vs. 91.3 ± 16.9 minutes, P < 0.001). One-year weight loss outcomes were comparable between groups.
Conclusion:
The in situ method appears feasible and may offer a shorter operative time compared with conventional LSG, although this finding should be interpreted cautiously in view of the study's retrospective design and limited sample size.