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The effect of bougie size and distance from the pylorus on dehydration after laparoscopic sleeve gastrectomy: an analysis of the ACS-MBSAQIP database

Published:August 24, 2019DOI:https://doi.org/10.1016/j.soard.2019.08.014

      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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