title: Comparison between orogastric tube/bougie and a suction calibration system for effects on operative duration, staple-line corkscrewing, and esophageal perforation during laparoscopic sleeve gastrectomy.
abstract: BACKGROUND
  Placement of a bougie for sleeve sizing during laparoscopic sleeve gastrectomy (LSG) is recommended. We compared this standard with a suction calibration system (SCS) that performs all functions with one insertion, and measured each step's duration.
  
  
  METHODS
  Primary LSG was performed using a bougie and SCS in alternating order. Number of tube movements to achieve optimal placement, durations of decompression, leak testing, and overall operative time, and remnant linear measurements were obtained.
  
  
  RESULTS
  LSG was performed in 26 patients (15 women, 11 men; mean age 36.8 years; mean BMI 45.3 kg/m(2)). The mean number of tube movements was significantly greater for the bougie than for the SCS (8.13 vs. 3.58; p < 0.0001). Percent reductions achieved using the SCS were: time to full decompression of the stomach, 62% (21 vs. 8 s; p < 0.138); tube placement, 51% (101 vs. 49 s; p < 0.0001); leak testing, 78% (119 vs. 26 s; p < 0.0003); and mean operative duration (from tube insertion to end of stapling), 21% (875 vs. 697 s; p < 0.019). Variance of the staple-line distance, measured from the greater curvature to the staple line, was 1.64 and 0.92 for the bougie and SCS, respectively, indicating a reduction in corkscrewing, for a 43.9% straighter sleeve.
  
  
  CONCLUSIONS
  SCS maintained the gastric wall in place, thereby preventing corkscrewing, and reducing total operating time. Reducing the number of tube insertions may prevent esophageal damage and accidental tube stapling.
authors.affiliation: Department of Surgery, Hospital du Sacre Coeur, Montreal, QC, Canada. gagner.michel@gmail.com.
authors.forename: Michel
authors.initials: M
authors.lastname: Gagner
authors.affiliation: Boehringer Laboratories, LLC, Phoenixville, PA, USA.
authors.forename: Rose Y
authors.initials: RY
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002138:Calibration; D004939:Esophageal Perforation / Q000209:etiology* / Q000601:surgery; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D011446:Prospective Studies; D013270:Stomach / Q000601:surgery; D013396:Suction / Q000379:methods*; D017792:Surgical Stapling / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult
keywords: Bougie; Calibration system; Corkscrewing; Delineation; Sleeve gastrectomy; ViSiGi 3D™