Surgical techniques do matter in laproscopic sleeve gastrectomy: JAMA

Key findings of the study were;

♦After assessing the videos the researchers found higher ratings for complete mobilization of fundus were tied to a significant decrease in 30-day hemorrhage rate, dropping from 2.1% down to 1.0% but associated with higher leak rates from 0.05% to 0.16%

♦Additionally, they found higher ratings for visualization of the left crus were associated with a decrease in hemorrhage rate from 1.5% to 0.94%and with an increase in leak rate from 0.1% to 0.2%.

♦They also noted higher ratings for a complete division of the short gastrics were associated with a decrease in hemorrhage rate from 2.8% to 1.2% with an increase in leak rate from 0.02% to 0.1%

♦They observed surgeons who stapled more tightly to the bougie had smaller decreases in reflux than those who stapled less tightly.

♦They found Staple line reinforcement (buttressing and oversewing) was associated with a small (2 of 1000 cases) decrease in hemorrhage rates and Staple line buttressing was also associated with a similarly small increase in leak rates but was found to be statistically insignificant.

"The clearest signal we got from the study is that completely dissecting out the proximal stomach is essential -- it is associated with better weight loss and reflux outcomes as well as lower bleeding rates," Chhabra told in an interview.

The authors concluded that Variations in surgical technique can be measured by video review and it helps to improve the quality of surgical care and outcomes for patients everywhere.

For further information:

https://jamanetwork.com/journals/jamasurgery/article-abstract/2773954