Highlights
- •Dehydration is the most common cause for readmission following laparoscopic sleeve gastrectomy.
- •Many technical aspects of laparoscopic sleeve gastrectomy, including the size of the bougie and the distance from the pylorus, are not standardized across institutions or surgeons.
- •These technical aspects of laparoscopic sleeve gastrectomy have been postulated to be associated with the rate of dehydration following laparoscopic sleeve gastrectomy.
- •Using the ACS-MBSAQIP database, we found that patients whose sleeve gastrectomy is begun ≥ 4 centimeters from the pylorus with a bougie size <36 French are least likely to experience dehydration following laparoscopic sleeve gastrectomy compared to any other combination of bougie size and distance from the pylorus.
- •We believe that a more standardized approach to laparoscopic sleeve gastrectomy may facilitate a decrease in early readmission rates and will lead to a substantial cost-savings benefit.
Abstract
Background
Dehydration is the most common cause of readmission after laparoscopic sleeve gastrectomy
(SG). Bougie size and distance from the pylorus, both of which have been associated
with rates of dehydration postoperatively, varies by surgeon and across institutions.
Objectives
To determine if there is an association between bougie size or distance from the pylorus
on the rate of dehydration after laparoscopic SG.
Setting
American College of Surgeons Metabolic and Bariatric Surgery Accreditation Quality
Improvement Program database.
Methods
All patients undergoing first-time, elective laparoscopic SG from 2015–2016 were identified.
The association of bougie size and distance from the pylorus on the rate of dehydration
within the first 30 days postoperatively was investigated.
Results
The inclusion criteria were met by 170,751 patients. The most commonly used bougie
size was 36 Fr and the most common distance from the pylorus at which the gastric
sleeve was started was 5 cm. Patients were divided into 4 groups based on bougie size
and distance from the pylorus (Group 1: bougie size <36 Fr, pylorus distance <4 cm;
Group 2: bougie size ≥36 Fr, pylorus distance <4 cm; Group 3: bougie size ≥36 Fr,
pylorus distance ≥4 cm; and Group 4: bougie size <36 Fr, pylorus distance ≥4 cm).
Patients in Group 4 were significantly less likely than any other group to experience
dehydration-related complications.
Conclusion
Both distance from the pylorus and bougie size are significantly associated with dehydration-related
complications after SG. Consideration should be made for standardizing these technical
aspects of SG to help reduce the rate of postoperative dehydration and hospital readmission.
Key words
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Article Info
Publication History
Published online: August 24, 2019
Accepted:
August 15,
2019
Received:
June 1,
2019
Identification
Copyright
© 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
