Laparoscopic Sleeve Gastrectomy: Investigation of Fundus Wall Thickness and Staple Height—an Observational Cohort Study: Fundus Wall Thickness and Leaks

• Published in: Obesity surgery 2017-12, Vol.27 (12), p.3209-3214
• Main Authors: Boeker, Clara, Mall, Julian, Reetz, Christian, Yamac, Kamil, Wilkens, Ludwig, Stroh, Christine, Koehler, Hinrich
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Anastomotic Leak - etiology; Anastomotic Leak - pathology; Cohort Studies; Esophagogastric Junction - surgery; Female; Gastrectomy - adverse effects; Gastrectomy - methods; Gastric Fundus - pathology; Gastric Fundus - surgery; Humans; Laparoscopy - adverse effects; Laparoscopy - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Obesity, Morbid - pathology; Obesity, Morbid - surgery; Organ Size - physiology; Original Contributions; Risk Factors; Surgery; Surgical Stapling - adverse effects; Surgical Stapling - methods; Young Adult
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-017-2755-x

Background Staple line leakage is a well-known complication after laparoscopic sleeve gastrectomy (LSG). Gastric wall thickness and the staple height may be determining factors for the occurrence of insufficiencies. To investigate this problem, an observational cohort study was carried out. Investigation concentrated on the gastroesophageal junction close to the angle of His, since this area is at highest risk for a leakage. Methods Fundus wall thickness of 141 specimens after LSG was measured by light microscopy at a predetermined location by a blinded pathologist. Furthermore, fundus wall thickness was compared with demographic data, clinical outcome, and the rate of insufficiencies. Results One hundred forty-one patients, 38 male and 103 female undergoing LSG, between January 2014 and July 2015 were included in the study. Male gender was associated with thicker gastric fundus wall. Overall leak rate was 2.1% (3/141). Median wall thickness of the 3 patients with detected leaks in the study group was thinner compared to the non-leak group (2810 vs. 3249 μm, respectively). Discussion/Conclusion Only male gender correlated with higher wall thickness of the fundus. The fact that all three patients who developed a leak were female, and the fundus of female patients as well as those of the leak group was thinner, indicates that wall thickness may have an impact on the rate of staple line leakage. Further studies with larger patient cohorts are needed.