Overretraction May Cause Gastrectomy Sleeve Stenosis

Overretracting the greater curvature is likely to be the cause of the majority of symptomatic stenoses (SS) following laparoscopic sleeve gastrectomy (LSG), according to a new study.

Researchers at the University of Texas (UT) Health Sciences Center (San Antonio, USA; www.uthscsa.edu) conducted a retrospective study of 230 patients (83% female, mean age 49.5 years, and a mean body mass index (BMI) of 43) who underwent LSG between October 2008 and December 2010 to determine the incidence, etiology, and management options for SS after LSG. The operative technique used a 36 French bougie with a buttressed staple line, as well as selective segmental suture imbrication of the staple line, based on the surgeon’s judgment. All patients underwent an intraoperative leak test by esophagogastroduodenoscopy.

The researchers found that the overall rate of major complications was 9.5%, with a 3.5% stenosis rate and a 3% bleeding rate. Of these, eight patients had short-segment stenosis; all of the patients were managed successfully using endoscopic balloon dilation. The patients with SS were found to be significantly younger than the other patients were. The researchers also found that most short-segment SS can be managed endoscopically, but for long-segment stenosis, complications are more likely to require conversion to bypass. The study was published in the November 2011 issue of Surgical Endoscopy.

“Overretraction may cause the stomach to be stretched over the bougie, which can be misleading in terms of how much space you are actually leaving behind when you take the bougie out and the pouch recoils,” said lead author Amit Parikh, DO, of the department of surgery.“Meticulous technique is of utmost importance, specifically focusing on avoiding over-retraction at the greater curve during division of the stomach as well as not overly abutting the bougie when the division is taking place.”

LSG is a restrictive form of weight loss surgery intended for the morbidly obese, which permanently reduces the size of the stomach by removing the lateral 2/3rds of the stomach with a stapling device. While the stomach is drastically reduced in size, its function is preserved, and there is no malabsorption of nutrients and supplements. LSG avoids the problems associated with bypass forms of weight loss surgery including anemia, intestinal obstruction or blockage, osteoporosis, and protein and vitamin deficiency, since about 100-200 mL of stomach capacity is maintained and there are very few restrictions on food consumption.

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