title: Laparoscopic Sleeve Gastrectomy With or Without Staple Line Inversion and Distal Fixation to the Transverse Mesocolon: Impact on Early Postoperative Outcomes.
abstract: Staple line complications and axial rotation of the gastric tube after sleeve gastrectomy are well-recognized complications of the procedure. The present study aims to investigate the role of staple line inversion and distal fixation to the transverse mesocolon in reducing these complications.
  
  
  
  This is a retrospective analysis of prospectively collected data of 252 patients with morbid obesity who underwent laparoscopic sleeve gastrectomy (LSG). Patients were subdivided into two groups: group I comprising 124 patients did not have distal sleeve fixation and group II comprising 128 patients underwent staple line inversion and distal fixation.
  
  
  
  Patients were 171 females and 81 males with a mean age of 33.2 ± 8.7 years and a mean preoperative body mass index (BMI) of 50.9 ± 8.6 Kg/m2. The mean operating time was 103.9 ± 26.9 min and the median hospital stay was 1 day. Major complications were detected in 15 (5.9 %) patients, who were all in group I. Group I had significantly shorter operative time and significantly higher rates of staple line bleeding (4 % in group I versus 0 in group II) and gastric axial rotation (5.6 % in group I versus 0 in group II). There were no significant differences between the two groups regarding early postoperative vomiting (21.7 % versus 26.5 %) and staple line leak (2.4 % versus 0).
  
  
  
  Staple line inversion and distal fixation to the transverse mesocolon can be a simple, effective strategy to prevent staple line bleeding, and gastric axial rotation, though it prolonged the operative time of LSG.
authors.affiliation: General surgery department, Faculty of Medicine, Mansoura University Hospitals, Elgomhuoria Street, Mansoura city, Egypt.
authors.forename: Emad
authors.initials: E
authors.lastname: Abdallah
authors.affiliation: General surgery department, Faculty of Medicine, Mansoura University Hospitals, Elgomhuoria Street, Mansoura city, Egypt. sameh200@hotmail.com.
authors.forename: Sameh Hany
authors.initials: SH
authors.lastname: Emile
authors.affiliation: General surgery department, Faculty of Medicine, Mansoura University Hospitals, Elgomhuoria Street, Mansoura city, Egypt.
authors.forename: Hossam
authors.initials: H
authors.lastname: Elfeki
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008646:Mesocolon / Q000601:surgery*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D061646:Operative Time; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology / Q000209:etiology; D011184:Postoperative Period; D012189:Retrospective Studies; D012399:Rotation; D017792:Surgical Stapling / Q000009:adverse effects / Q000379:methods*; D054159:Torsion, Mechanical; D016896:Treatment Outcome; D055815:Young Adult
keywords: Axial rotation; Early outcome; Sleeve fixation; Sleeve gastrectomy