Measurement of Stomach Wall Thickness to Guide Staple Selection during Sleeve Gastrectomy
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ORIGINAL CONTRIBUTIONS
Measurement of Stomach Wall Thickness to Guide Staple Selection during Sleeve Gastrectomy Yoo Jin Lee 1 & You Na Kim 2
&
Sungsoo Park 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Sleeve gastrectomy has been considered a primary bariatric surgery; however, surgeons concerned with staple line leakage often query whether staples selected during stomach resection are of an appropriate size. This study aimed to measure gastric wall thickness using pathology laboratory measurements and to identify variables correlated with stomach wall thickness in patients who had undergone laparoscopic sleeve gastrectomy. Methods We obtained fresh resected stomach wall specimens from 30 patients. Stomach wall thickness was immediately measured postoperatively, comprising the muscle layer of the antrum, body, and fundus. Results were correlated with body mass index (BMI), age, and sex and with diagnoses of presurgical diabetes, hypertension, hyperlipidemia, and fatty liver. Results Stomach wall thickness ranged from 3.4 ± 4.3 mm to 1.0 ± 9.6 mm at the antrum. Except for the whole layer at the body wall, there was no significant correlation between wall thickness and other factors. At the body wall, whole layer wall thickness was found to positively correlate with age, sex, diabetes, and smoking (r = 0.469, − 0.391, 0.396, and 0.349, respectively; p < 0.05 in all patients). Conclusion Stomach wall thickness varied among patients who had undergone laparoscopic sleeve gastrectomy according to samples taken at three stomach wall sites. The range in wall thickness was normal, and thus, surgeons need not hesitate in selecting the staple height. Also, our study may be helpful to guide surgeon choice concerning the third or fourth staple around the body area when considering a patient’s independent factors. Keywords Stomach wall thickness . Laparoscopic sleeve gastrectomy . Staple height
Introduction Laparoscopic sleeve gastrectomy (LSG) is emerging as a popular bariatric procedure and a stand-alone procedure for morbid obesity [1–3]. This procedure has been reported to have adequate outcomes concerning weight loss and changes to hormonal mechanisms [4], and there are many advantages with this simpler technique, such as the lack of gastrointestinal anastomosis and the prevention of internal hernia development [5]. LSG use * You Na Kim [email protected] 1
Department of Pathology, Korea University Anam Hospital, South Korea University College of Medicine, Seoul, South Korea
2
Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
has increased in Asia, where there is a high incidence of stomach cancer, and has the advantage of a possibility for remnant stomach evaluation through endoscopy. However, some controversial aspects of LSG should also be considered. When vertical transection of the stomach is performed using an endoscopic linear stapler, prevention of major complications such as leakage and bleeding is mo
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