title: Impact of Botulinum Neurotoxin Pyloric Injection During Laparoscopic Sleeve Gastrectomy on Postoperative Gastric Leak: a Clinical Randomized Study.
abstract: BACKGROUND
  The most frequent and most feared complication after laparoscopic sleeve gastrectomy (LSG) is gastric leak (GL). We hypothesize that botulinum neurotoxin (botulinum type A (BTX-A)) injection into the pyloric sphincter muscle at the time of operation may decrease the risk of postoperative GL.
  
  
  METHODS
  Consecutive patients with morbid obesity (MO) treated by LSG were enrolled. Patients were randomly allocated into two groups: group I (intrapyloric BTX-A injection was performed) and group II (no injection was performed). The primary outcome measure was number of patients developing GL. Secondary outcome measures were percent of excess weight loss, postoperative complications, and their management.
  
  
  RESULTS
  One hundred and fifteen patients (86 (74.8 %) females) were randomized into two groups of 57 patients (group I) and 58 patients (group II). Four patients in group II developed GL versus no patient in group I (P = 0.04). Ten patients in group I and two in group II developed refractory epigastric pain (P = 0.01). Other complication rates were comparable for both groups. Mean preoperative BMI of patients in both groups had significantly decreased from 54.64 ± 6.82 to 42.99 ± 5.3 at 6 months and to 39.09 ± 5.14 at 12 months (P < 0.001).
  
  
  CONCLUSIONS
  LSG is an effective, safe, and minimally invasive procedure for treatment of MO. No patient in whom pyloric BTX-A injection was performed developed postoperative GL versus four patients in whom injection was not performed. The difference in GL rate was statistically significant, thus favoring the use of pyloric BTX-A injection during LSG.
authors.affiliation: General and Endocrine Surgery, Mansoura Faculty of Medicine, Mansoura University, Gomhoria St., Mansoura, Egypt. tamyousif@yahoo.com.
authors.forename: Tamer
authors.initials: T
authors.lastname: Youssef
authors.affiliation: General Surgery, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt.
authors.forename: Emad
authors.initials: E
authors.lastname: Abdalla
authors.affiliation: General Surgery, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt.
authors.forename: Khalid
authors.initials: K
authors.lastname: El-Alfy
authors.affiliation: General Surgery, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Dawoud
authors.affiliation: General Surgery, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt.
authors.forename: Mosaad
authors.initials: M
authors.lastname: Morshed
authors.affiliation: General Surgery, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Farid
mesh_terms: D000328:Adult; D015992:Body Mass Index; D001905:Botulinum Toxins / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*; D011184:Postoperative Period; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult
chemical_list: D001905:Botulinum Toxins
keywords: Botulinum neurotoxin type A; Gastric leak; Laparoscopic sleeve gastrectomy; Morbid obesity