The Effects of Bougie Diameters on Tissue Oxygen Levels After Sleeve Gastrectomy: A Randomized Experimental Trial

The Effects of Bougie Diameters on Tissue Oxygen Levels After Sleeve Gastrectomy: A Randomized Experimental Trial

Background: Staple-line leak is the most frightening complication oflaparoscopic sleeve gastrectomy and several predisposing factors suchas using improper staple sizes regardless of gastric wall thickness,narrower bougie diameter and ischemia of the staple line are asserted.Aims: To evaluate the effects of different bougie diameters on tissueoxygen partial pressure at the esophagogastric junction after sleevegastrectomy.Study Design: A randomized and controlled animal experiment with1:1:1:1 allocation ratio.Methods: Thirty-two male Wistar Albino rats were randomly dividedinto 4 groups of 8 each. While 12-Fr bougies were used in groups1 and 3, 8-Fr bougies were used in groups 2 and 4. Fibrin sealantapplication was also carried out around the gastrectomy line aftersleeve gastrectomy in groups 3 and 4. Burst pressure of gastrectomyline, tissue oxygen partial pressure and hydroxyproline levels atthe esophagogastric junction were measured and compared amonggroups.Results: Mortality was detected in 2 out of 32 rats (6.25%) and one ofthem was in group 2 and the cause of this mortality was gastric leak.Gastric leak was detected in 2 out of 32 rats (6.25%). There was nosignificant difference in terms of burst pressures, tissue oxygen partialpressure and tissue hydroxyproline levels among the 4 groups.Conclusion: The use of narrower bougie along with fibrin sealant hasnot had a negative effect on tissue perfusion and wound healing.

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  • Nguyen NT, Nguyen CT, Stevens CM, Steward E, Paya M. The efficacy of fibrin sealant in prevention of anastomotic leak after laparoscopic gastric bypass. J Surg Res 2004;122:218-24.
  • Liu CD, Glantz GJ, Livingston EH. Fibrin glue as a sealant for high-risk anastomosis in surgery for morbid obesity. Obes Surg 2003;13:45-8.
  • Sapala JA, Wood MH, Schuhknecht MP. Anastomotic leak prophylaxis using a vapor- heated fibrin sealant: report on 738 gastric bypass patients. Obes Surg 2004;14:35-42.
  • Natoudi M, Theodorou D, Papalois A, Drymousis P, Alevizos L, Katsaragakis S, et al. Does tissue ischemia actually contribute to leak after sleeve gastrectomy? An experimental study. Obes Surg 2014;24:675-83.
  • Saber AA, Azar N, Dekal M, Abdelbaki TN. Computed tomographic scan mapping of gastric wall perfusion and clinical implications. Am J Surg 2015;209:999-1006.
  • Gomes M, Ramacciotti E, Miranda F Jr, Henriques AC, Fagundes DJ. Vascular flow of the gastric fundus after arterial devascularization: an experimental study. J Surg Res 2009;152:128-34.
  • Parikh M, Issa R, McCrillis A, Saunders JK, Ude-Welcome A, Gagner M. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg 2013;257:231-7.
  • Yuval JB, Mintz Y, Cohen MJ, Rivkind AI, Elazary R. The effects of bougie caliber on leaks and excess weight loss following laparoscopic sleeve gastrectomy. Is there an ideal bougie size? Obes Surg 2013;23:1685-91.
  • Cal P, Deluca L, Jakob T, Fernández E. Laparoscopic sleeve gastrectomy with 27 versus 39 Fr bougie calibration: a randomized controlled trial. Surg Endosc 2016;30:1812-5.
  • Parikh M, Gagner M, Heacock L, Strain G, Dakin G, Pomp A. Laparoscopic sleeve gastrectomy: does bougie size affect mean %EWL? Short-term outcomes. Surg Obes Relat Dis 2008;4:528-33.
  • Abd Ellatif ME, Abdallah E, Askar W, Thabet W, Aboushady M, Abbas AE, et al. Long term predictors of success after laparoscopic sleeve gastrectomy. Int J Surg 2014;12:504-8.
  • Atkins ER, Preen DB, Jarman C, Cohen LD. Improved obesity reduction and co- morbidity resolution in patients treated with 40-French bougie versus 50-French bougie four years after laparoscopic sleeve gastrectomy. Analysis of 294 patients. Obes Surg 2012;22:97-104.
  • Sidney Siegel NJCJ. The Friedman Two-Way Analysis of Variance by Ranks. in Nonparametric Statistics for the Behavioral Sciences. New York: 1988, McGraw-Hill Inc; 1988:174-83.
  • Jamall IS, Finelli VN, Que Hee SS. A simple method to determine nanogram levels of 4-hydroxyproline in biological tissues. Anal Biochem 1981;112:70-5.
  • Kuzu MA, Köksoy C, Kale IT, Tanik A, Terzi C, Elhan AH. Reperfusion injury delays healing of intestinal anastomosis in a rat. Am J Surg 1998;176:348-51.
  • van Rutte PW, Naagen BJ, Spek M, Jakimowicz JJ, Nienhuijs SW, Gastric Wall Thickness in Sleeve Gastrectomy Patients: Thickness Variation of the Gastric Wall. Surg Technol Int 2015;27:123-8.
  • Tan JT, Kariyawasam S, Wijeratne T, Chandraratna HS. Diagnosis and management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg 2010;20:403-9.
  • Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4.888 patients. Surg Endosc 2012;26:1509-15.
  • Genc V, Sulaimanov M, Kırımker EO, Sevim Y, Ensari C. The use of porcine acellular dermal matrix for management of gastrocutaneous fistula after laparoscopic sleeve gastrectomy. J Laparoendosc Adv Surg Tech A 2015;25:401-5.
  • Zhang N, Maffei A, Cerabona T, Pahuja A, Omana J, Kaul A. Reduction in obesity- related comorbidities: is gastric bypass better than sleeve gastrectomy? Surg Endosc 2013;27:1273-80.
  • Lim DM, Taller J, Bertucci W, Riffenburgh RH, O'Leary J, Wisbach G. Comparison of laparoscopic sleeve gastrectomy to laparoscopic Roux-en-Y gastric bypass for morbid obesity in a military institution. Surg Obes Relat Dis 2014;10:269-76.
  • Regan JP, Inabnet WB, Gagner M, Pomp A. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg 2003;13:861-4.
  • Angrisani L, Santonicola A, Iovino P, Formisano G, Buchwald H, Scopinaro N. Bariatric Surgery Worldwide 2013. Obes Surg 2015;25:1822-32.
  • World Health Organization (WHO), "Data and Statistics on Obesity". [cited 2016 December 9]; Available from: http://www.euro.who.int/en/health-topics/ noncommunicable-diseases/obesity/data-and-statistics.
Balkan Medical Journal-Cover
  • ISSN: 2146-3123
  • Başlangıç: 2015
  • Yayıncı: Erkan Mor
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