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.
- 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.