The Impact of Technical Surgical Aspects on Morbidity of 984 Patients after Sleeve Gastrectomy for Morbid Obesity.

Background: To evaluate early complications after LSG in regard of staple line reinforcement (SLR), bougie size, previous bariatric surgery and surgeon experience. Methods: A retrospective cohort study of LSG patients at the Soroka University Medical Center (SUMC). Data was collected from digitalized database. Results: Nine hundred eighty-four LSG cases were performed by three surgeons. Seventy-eight complications were observed (7.9%): 44 mild (4.5%) and 34 severe (3.4%). Over-sewing of staple line was performed in 689 cases (76.2%), and no SLR in 217 cases (24.0%) without significant impact on mild or severe early morbidity. Bougie size 36 Fr or smaller was used in 635 cases (73.0%) without significant differences in early complications compared to 235 cases (27.0%) with larger bougie. LSG, as revision bariatric surgery, was performed in 273 cases (27.7%). Concomitant removal of a gastric band was performed in 199 of these cases (72.9%). History of silastic ring vertical gastroplasty (SRVG) was recorded in 10 cases (1.0%). Previous bariatric surgery was a significant risk factor for early mild complications (OR = 1.14, p value = 0.02), but not for severe ones (OR = 0.79, p value = 0.09). Concomitant removal of gastric band did not affect this result. The risk for mild complication was significantly reduced with surgeon experience achieving 100 cases. Conclusions: SLR or bougie size is not affecting LSG morbidity, but previous bariatric history and surgeon experience are significant factors for early mild complications.