Michel Gagner, Clinical Professor of Surgery at Hôpital Sacré-Coeur in Montréal (Canada) reviews the changes in the consensus statements on the sleeve gastrectomy technique , from the 2012 statement to the 2016 consensus.
In this video, he reviews the key steps to perform the ideal sleeve gastrectomy and discusses several controversial aspects.
A discussion on the main controversies on sleeve gastrectomy includes:
- Does the size of the bougie impact the leak rate?
- Does the distance from the pylorus have an impact on leak rate?
- Are there any differences in weight loss with different bougie sizes?
- Is buttress material useful to reduce blood loss and leaks?
- Is the repair of a hiatal hernia necessary when it is diagnosed intraoperatively?
Recommendations on how to avoid leaks include:
- Use bougie size ≥ 40 Fr.
- Begin gastric transection 5-6 cm from the pylorus.
- Use appropriate cartridge colors from the antrum to the fundus.
- Reinforce the staple line with buttress material.
- Follow a proper staple line.
- Remove the crotch staples.
- Maintain proper traction of the stomach before firing.
- Stay at least 1 cm away from the angle of His.
- Check the bleeding from the staple line.
- Perform an intraoperative methylene blue test.
Conclusion
- The use of an absorbable buttress material during performance of a sleeve gastrectomy reduces the incidence of postoperative leaks two/threefold .
- This is stronger than suturing alone.
- Intra-operative strategies have an impact on postoperative complications including bleeding and leaks after sleeve gastrectomy.
