Background and aim: Staple line complications and axial rotation of the gastric tube after sleeve gastrectomy are well-recognized complications of the procedure. The present study aims to investigate the role of staple line inversion and distal fixation to the transverse mesocolon in reducing these complications.
Patients and methods: This is a retrospective analysis of prospectively collected data of 252 patients with morbid obesity who underwent laparoscopic sleeve gastrectomy (LSG). Patients were subdivided into two groups: group I comprising 124 patients did not have distal sleeve fixation and group II comprising 128 patients underwent staple line inversion and distal fixation.
Results: Patients were 171 females and 81 males with a mean age of 33.2 ± 8.7 years and a mean preoperative body mass index (BMI) of 50.9 ± 8.6 Kg/m2. The mean operating time was 103.9 ± 26.9 min and the median hospital stay was 1 day. Major complications were detected in 15 (5.9 %) patients, who were all in group I. Group I had significantly shorter operative time and significantly higher rates of staple line bleeding (4 % in group I versus 0 in group II) and gastric axial rotation (5.6 % in group I versus 0 in group II). There were no significant differences between the two groups regarding early postoperative vomiting (21.7 % versus 26.5 %) and staple line leak (2.4 % versus 0).
Conclusion: Staple line inversion and distal fixation to the transverse mesocolon can be a simple, effective strategy to prevent staple line bleeding, and gastric axial rotation, though it prolonged the operative time of LSG.
Keywords: Axial rotation; Early outcome; Sleeve fixation; Sleeve gastrectomy.