Background

One of the most debated issues in the practice of sleeve gastrectomy (SG) is the size of the bougie used during procedures. While larger size (50-Fr to 60-Fr) bougies initially used in SG are generally avoided these days, it has been suggested that the optimal size should be well below 40-Fr.

Methods

Literature search was done according to the PRISMA guidelines. Meta-analysis was done using the RevMen 5.4.1 software. Statistical method used was Mantel-Haenszel. Analysis model used was random effects regardless of the heterogeneity (I2).

Results

Meta-analysis of randomized controlled trials comparing 32 Fr vs 40 Fr Bougie use during sleeve gastrectomy revealed statistically insignificant increase in length of stay (MD 0.29, CI -0.25, 0.83), vomiting (OR 3.17, CI 0.61, 16.55), readmissions (OR 2.52, CI 0.43, 14.57), re-operations (OR 1.40, CI 0.17, 11.77), leaks (OR 1.48, CI 0.23, 9.59), bleeding (OR 1.05, CI 0.21, 5.21), overall complications (OR 1.43, CI 0.54, 3.81), and excess weight loss percentage (EWL%) at 6 months (MD 2.19, CI -2.76, 7.14). In addition, analysis revealed statistically insignificant decrease in operative time (MD -1.15, CI -5.73, 3.42), surgical site infections (OR 0.65, CI 0.22, 1.94), diabetes resolution (OR 0.76, CI 0.20, 2.87), hypertension resolution (OR 0.85, CI 0.18, 4.06), and obstructive sleep apnea resolution (OR 0.46, CI 0.04, 5.78).

Conclusions

No significant difference was observed. This review’s limitation is that it is based on small number of randomized controlled trials, as only few are available in the literature.