title: Impact of the Surgical Experience on Leak Rate After Laparoscopic Sleeve Gastrectomy.
abstract: Laparoscopic sleeve gastrectomy (LSG) has become one of the most commonly performed bariatric procedures, largely due to several advantages it carries over more complex bariatric procedures. LSG is generally considered a straightforward procedure, but one of the major concerns is a staple line leak.
  
  
  
  The objectives of this study are to evaluate the correlation between surgeon's experience and leak rate and to assess the different risk factors for developing a gastric leak after LSG.
  
  
  
  Private hospital, France.
  
  
  
  The analysis of a single surgeon's yearly leak rate since the introduction of LSG for possible risk factors was done.
  
  
  
  A total of 2012 LSGs were performed in between September, 2005 and December, 2014. Twenty cases (1 %) of gastric leak were recorded. Of these, 17 patients were women (94.4 %) with a mean age of 39.4 years (range 22-61) and mean body mass index (BMI) 41.2 kg/m(2) (range 34.8-57.1). On a yearly basis, the leak rate was 4.8 % (2006), 5.7 % (2007), 0 (2008), 2.6 % (2009), 2 % (2010), 0.8 % (2011), 0.6 % (2012), 0.2 % (2013), and 0 (2014). In the first 1000 cases (group A), there were 18 cases of gastric leak and in the last 1000 cases, there were 800 with GORE® SEAMGUARD® Bioabsorbable Staple Line Reinforcement (group B) 2 cases of gastric leak (p = 0.009). A revisional LSG, 395 patients after gastric banding and 61 patients re-sleeve gastrectomy, was performed in 456 cases (22.7 %). There were 3 cases of leak (0.65 %). There were two deaths.
  
  
  
  LSG can be performed with a low complication rate. This large series of a single surgeon's experience demonstrated that the leak rate after LSG could be significantly decreased over time with changes in techniques.
authors.affiliation: Hôpital Prive La Casamance, Aubagne, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Noel
authors.affiliation: Digestive and Endocrine Surgery, University Hospital of Strasbourg, 1, Place de l'Hôpital, 67091, Strasbourg, France. nedelcu.marius@gmail.com.
authors.forename: Marius
authors.initials: M
authors.lastname: Nedelcu
authors.affiliation: Hôpital Du Sacré Cœur, Montréal, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Gagner
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000453:epidemiology*; D015992:Body Mass Index; D005260:Female; D005602:France / Q000453:epidemiology; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D017792:Surgical Stapling / Q000379:methods; D015431:Weight Loss; D055815:Young Adult
keywords: Leak; Revisional surgery; Sleeve; Surgeon’s experience