Background
A number of operative technical modifications have been suggested for laparoscopic sleeve gastrectomy in order to optimise postoperative weight loss and minimise complications. These include staple line reinforcement and omentopexy.
Objectives
To evaluate weight loss and complication rates in patients undergoing laparoscopic sleeve gastrectomy using non-buttressed staples without omentopexy.
Methods
Laparoscopic sleeve gastrectomy was performed using a size 40 Bougie. Unbuttressed staples were utilised. No omentopexy was performed. Hiatal repairs were performed in the presence of a hiatal defect.
Patient anthropometric data, comorbidity data and acid suppression medication use were recorded prospectively. At twelve month follow-up weight loss, post-operative readmission to hospital and acid suppression medication use were recorded.
Results
Over an eight month period, 110 consecutive patients underwent laparoscopic sleeve gastrectomy. The median age was 40 years (range 19-68), and 89% of the cohort were females. The median weight was 115kg (range 82-205kg), and the median BMI was 42 (range 30-60). Twelve month follow-up was available for 95 patients (86%). Twenty two patients (20%) underwent an anterior hiatal repair. One patient required hospital readmission for vomiting. There were no staple line leaks. There were no recorded cases of gastric torsion. Four patients who required regular acid suppression medication pre-operatively continued post-operatively, one ceased, while 15 other patients commenced acid suppression medication for reflux symptoms post-operatively.
Conclusion
Omission of staple line buttressing and routine omentopexy resulted in acceptable rates of staple line leak and gastric torsion.