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IFSO 2012

Bougie lessons from LSG results

Jose Salines achieved mean five-year EWL of 79.1% in 160 patients
Michel Gagner suggests Salines' choice of bougie size led to high failure rate
Michel Gagner (above) criticised the speaker Jose Salines' choice of bougie after his talk.

The outcomes from a long term studies assessing the effectiveness of laparoscopic sleeve gastrectomy (LSG) have reported effective weight loss coupled with low complications rates. Although the results were largely positive, the size of the bougie drew criticism from the audience.

Jose Salines (Chile) presented his centre’s five-year study that examined LSG as a stand-alone procedure. Between December 2005 and June 2007, 160 patients with an average BMI 36.7 received a LSG, using a 60fr bougie.

There were two reoperations which included a sleeve stenosis (converted to bypass) and a single staple line leak (lavage and drainage) and six post-operative complications.

For patients with a pre-operative BMI<35, the mean five year EWL% was 79.1, with 17.2% losing less than 50% EWL. For patients with a pre-operative BMI 35-40, the mean five year EWL% was 67.8, with 20%  50% EWL. For patients with a pre-operative BMI>40, the mean five year EWL% was 45.8, with 77.7% losing less than 50% EWL. 

 “At five years, LSG was successful in 76.1% and the failure rate was highest in those patients with BMI>40,” concluded Salines. “LSG should be considered as a stand-alone procedure for those patients with a low BMI.”

Speaking from the audience, Michel Gagner commented that the reason the failure rate was probably so high was the use of 60fr bougie, and by reducing the bougie to 30 or 40, the failure rate could fall to as little as 10%.

“In our institution we use 40fr bougie to reduce the failure rate, and avoid over sewing to reduce strictures,” he added.

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