Predictors and outcomes of bleed after Sleeve Gastrectomy: An analysis of the MBSAQIP data registry
Bleeding following laparoscopic sleeve gastrectomy (LSG) is an important complication associated with significant morbidity and a drastic increase in healthcare resources. Multiple strategies have been developed to minimize bleeding including varying bougie size, staple line reinforcement, and intra-operative tranexamic acid. These techniques, however, have been implemented without a clear understanding of the pre-, intra-, and post-operative predictors of bleeding in patients undergoing sleeve gastrectomy.
I read with interest the manuscript entitled "Laparoscopic sleeve gastrectomy as day-case ambulatory surgery", more so since I am the owner of such an ambulatory surgical centre in a major urban area in Canada.1 My main concern for patients is similar to when laparoscopic cholecystectomy went from less than 24 hours stay (the next day) to discharge the same day. What if bleeding occurs at home, how would the patient and family react, and would they survive a haemorrhagic shock episode? The possible liability that follows, and negative publicity, as it may make the main headlines in your local area.
Abstract OBJECTIVE: The aim of this study was to evaluate the impact of high body mass index (BMI) on surgical outcome of laparoscopic gastrectomy for gastric cancer (GC). METHODS: Systematic literature search was performed using PubMed and Embase databases. The relevant data were extracted, and surgical outcomes and postoperative complications were compared between BMI≥25 kg/m2 and BMI
ConclusionsSLR significantly reduces bleeding and reoperation rates following SG and has no deleterious impact on staple line leak rate. While further prospective studies factoring in the SLR method and staple characteristics are needed, this large database analysis supports the use of routine SLR during SG to reduce the risk of perioperative bleeding and reoperation.
ConclusionsAlthough quality of all the studies was relatively moderate and the number of the included studies was limited, the barbed suture may have the potentiality to be an effective and reliable technique and extend the application in other bariatric surgeries. More evidence with randomized design, larger sample sizes, and longer follow-up need to compel validations of this state-of-the-art in the future.
Conclusion: Harmonic® and LigaSure™ are both useful tools in bariatric surgery, and these two advanced power devices are user-friendly and can facilitate surgeon work; from this point of view, the choice of the energy device should be based on the preference of the surgeon and on the hospital costs policy and availability. PMID: 30719344 [PubMed - in process]
Background: Roux-en-Y gastric bypass (LRYGB) and sleeve gastrectomy (SG) are the most commonly performed procedures worldwide, and because of recent evidence SG has become more accepted as stand-alone bariatric surgery. Bleeding from staple line represent about 1-2% of patient complications.
Background: Complications at the gastro-jejunostomy following roux-en-Y gastric bypass (RYGB) are well characterized and include leak, bleeding, marginal ulcer, gastro-gastric fistula, and anastomotic stricture. While conservative therapies and even some re-operative options can preserve the gastric pouch, repeat interventions and recurrent disease may require conversion to esophago-jejunostomy.
Background: Laparoscopic Sleeve Gastrectomy (LSG) has recently been recognized as a potential stand alone operation for the treatment of obesity worldwide.However,the incidence of postoperative nausea and vomiting is not uncommon in surgical practice,whereas other serious complications might occur including leakage or bleeding
The objective of this study was to assess the impact of using a gastric clamp on stapling efficiency and pouch quality.
Background: Stomach tissue thickness (TT) and surgeon-selected closed staple height (CSH) are important factors in the formation of an adequate staple line during laparoscopic sleeve gastrectomy (LSG). Staples need to have a CSH that is appropriate for a given TT in order to avoid staple malformation that may lead to leak or bleeding. Prior studies characterizing compressed stomach TT have used a loading pressure of 8g/mm2 to mimic stapling conditions. We hypothesize that 8g/mm2 is an inadequate loading pressure for measuring stomach TT.