title: Effect of perioperative management on short-term outcomes after sleeve gastrectomy: a 600-patient single-center cohort study.
abstract: BACKGROUND
  Reports on the postoperative outcomes of sleeve gastrectomy (SG) have only been from small, single-center series and meta-analyses of studies with variable SG management. The objective of this study was to evaluate post-SG outcomes in a specialized bariatric surgery center with a routinely performed standardized procedure.
  
  
  METHODS
  The postoperative complication rate, operating times, and postoperative data were evaluated from all patients undergoing a primary SG between November 2004 and February 2012. Results were analyzed for 3 separate surgical periods, which differed with perioperative management.
  
  
  RESULTS
  Of 600 patients (mean age: 41.8±11.3; mean body mass index [BMI]: 47.2±16 kg/m²; 80% were women who underwent primary SG), 26.8% had a BMI≥50 kg/m². The mean operating time was 84 minutes. The rate of conversion was 1%. There were no postoperative deaths. The overall complication rate was 8.5%; the major complication rate was 5.6%; the revisional surgery rate was 4.6% and the gastric leak rate was 2.5%. Over the course of the 3 study periods, the operating time fell from 91±32 to 79±22 minutes (P≤.001); the length of hospital stay decreased from 4.5±4.9 to 3.4±4.3 days (P = .02); the major complication rate fell from 6.4% to 5.5% (P = NS); and the gastric fistula rate decreased from 4.6% to 1.9% (P = NS).
  
  
  CONCLUSIONS
  In a specialist bariatric surgery center, SG had an acceptable complication rate. Modifications in the perioperative management of SG were associated with a shorter mean operating time and hospital stay and did not increase the major complication or gastric fistula rates.
authors.affiliation: Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardie, Place Victor Pauchet, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Rebibo
authors.affiliation: Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardie, Place Victor Pauchet, France.
authors.forename: Christelle
authors.initials: C
authors.lastname: Blot
authors.affiliation: Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardie, Place Victor Pauchet, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Verhaeghe
authors.affiliation: Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardie, Place Victor Pauchet, France.
authors.forename: Cyril
authors.initials: C
authors.lastname: Cosse
authors.affiliation: Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardie, Place Victor Pauchet, France.
authors.forename: Abdennaceur
authors.initials: A
authors.lastname: Dhahri
authors.affiliation: Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardie, Place Victor Pauchet, France. Electronic address: regimbeau.jean-marc@chu-amiens.fr.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Regimbeau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000379:methods*; D015992:Body Mass Index; D003251:Constriction, Pathologic / Q000209:etiology; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005747:Gastric Fistula / Q000209:etiology / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D019990:Perioperative Care; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D019106:Postoperative Hemorrhage / Q000209:etiology; D011446:Prospective Studies; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Complications after sleeve gastrectomy; Gastric fistula; Laparoscopic sleeve gastrectomy; Morbid obesity