Oversewing and Gastropexy in Laparoscopic Sleeve Gastrectomy - Two Futile Steps of the Procedure? An Observational Case-Control Study.

ABSTRACT

PURPOSE: Laparoscopic sleeve gastrectomy (LSG) is the most popular primary bariatric metabolic procedure worldwide but severe complications are still reported, and there is no ideal technique to avoid them. This study analyses the impact of oversewing (OS) and gastropexy (GP) on complication rate, early dyspeptic and late de novo GERD symptoms after LSG. MATERIAL AND METHOD: A case-control study was conducted on patients with obesity who underwent LSG. The total cohort was divided in group A (control group) - patients with no oversewing (OS) or gastropexy (GP), group B - patients with OS but no gastropexy and group C - patients with both OS and GP performed during LSG. RESULTS: We included 272 patients with obesity with a mean BMI 42.9±6.94 kg/m2, 96 patients in group A, 90 patients in group B and 86 in group C with no statistical differences between them. We had 5 cases of postoperative hemorrhage (4 in group A) and three patients who developed leaks (2 in group A and one in group B). Prolonged and severe early dyspeptic episodes and after 6 months reflux symptoms were significantly more in groups A and B (p<0.05). The operative time was longer in group B and C (p<0.05) but with no difference in procedure -related morbidity and in hospital length of stay. CONCLUSION: Adding both OS and GP to LSG reduce complications rate with no influence on procedure-related postoperative morbidity and in-hospital length of stay. GP reduces early postoperative dyspeptic and de novo GERD symptoms after LSG.