Background

Background: One of sleeve gastrectomy (SG)’s most dreaded complications is stenosis, which can present as narrowing at the incisura or longitudinal twist (functional stenosis). Twists may form postoperatively but are probably often present at index surgery. It is unknown whether fixating the crooked stapple line to the surrounding omentum or retroperitoneum can prevent symptomatic functional stenosis (FS). Objective: To evaluate the effect of running suture fixation of twisted sleeves on symptomatic FS and surgical revision.

Methods

We retrospectively reviewed prospectively collected data from 110 bariatric patients (85.5% females) who underwent SG between 2018 and 2022 at our institution. The cohort had a mean age of 45.3 years, BMI of 48.4 kg/m2 and follow-up of 14.8 months. 54 twisted sleeves were retrieved and were either fixated (group A, n=33) or not (group B, n=21) according to surgeon’s preference. 54 normal non-twisted sleeves were randomly selected as controls (group C). Follow-up data was collected for clinical GERD symptoms, FS on esophagogastroduodenoscopy and reoperation for FS.

Results

Symptomatic FS developed in 3% of group A, 9.5% of group B and 3.6% of group C. Surgical revision for FS occurred in 3% of group A, 4.8% of group B and 3.6% of group C. Sleeve fixation was associated with a significant decrease in post-operative GERD symptoms (OR 0.18; 95% CI 0.05-0.71).

Conclusions

Fixation of twisted sleeves may decrease post-operative GERD symptoms. More prospective randomized data is needed to confirm the possible trend toward decreasing the occurrence of FS upon fixation of twisted sleeves.