Measurement of gastric wall thickness following laparoscopic sleeve gastrectomy and analysis of its influencing factors_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YUAN Peiwen ¹ , HONG Jian ² , WANG Hui ² , Fidele Kakule Kitaghenda ¹ , SUN Xia ¹ , YAO Libin ² ,  ZHU Xiaocheng ²

1. Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu 221004, P. R. China;
2. Department of Bariatric Metabolic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, P. R. China;

Corresponding author：

ZHU Xiaocheng, Email: zhuxccf@163.com

Keywords：

laparoscopic sleeve gastrectomy; gastric wall thickness

DOI：

10.7507/1007-9424.202402045

Video：

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Objective To measure gastric wall thickness in patients with obesity and to investigate the relation between gastric wall thickness and clinicopathologic characteristics. Methods The clinicopathologic data of the patients who underwent laparoscopic sleeve gastrectomy (LSG) in the Affiliated Hospital of Xuzhou Medical University from February to August 2023 were collected. The gastric wall thickness of the gastric tissue specimens resected following LSG was measured by a tissue measuring device at 3 predetermined positions (gastric antrum, gastric body, and gastric fundus) at a compressive pressure of 8 g/mm², and multiple linear regression was used to analyze the factors affecting the thickness of the gastric wall. Results A total of 232 patients were collected in this study, including 49 males and 183 females. Preoperative body mass index (BMI) was 28.2–61.8 kg/m² with (38.4±5.3) kg/m², and the patients with BMI ≥40 kg/m² were 82 cases and <40 kg/m² were 150 cases. The thickness of the gastric wall in the gastric antrum, gastric body, and gastric fundus of 232 patients was (3.04±0.38) mm, (2.26±0.51) mm, and (1.63±0.32) mm, respectively. The results of multiple linear regression analysis showed that the thickness of the gastric wall at the gastric antrum was related to the gender of the patients, that is, the thickness of the gastric wall at the gastric antrum was thinner in the females as compared with the males (standard coefficients β=–0.152, t=–2.167, P=0.031), while the thickness of the gastric wall at the gastric fundus was related to the BMI of the patients, and the higher BMI, the thicker thickness of the gastric wall at the gastric fundus (standard coefficients β=0.153, t=2.281, P=0.023). Conclusions According to the results of this study, the thickness of the gastric wall is related to the anatomical position of the gastric wall. During LSG surgery, the size and height of the Staple lines are selected at different anatomical positions of the cutting edge for males and obese patients with higher BMI.

Citation： YUAN Peiwen, HONG Jian, WANG Hui, Fidele Kakule Kitaghenda, SUN Xia, YAO Libin, ZHU Xiaocheng. Measurement of gastric wall thickness following laparoscopic sleeve gastrectomy and analysis of its influencing factors. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(9): 1093-1098. doi: 10.7507/1007-9424.202402045 Copy

1.	Debs T, Petrucciani N, Kassir R, et al. Laparoscopic conversion of sleeve gastrectomy to one anastomosis gastric bypass for weight loss failure: mid-term results. Obes Surg, 2020, 30(6): 2259-2265.
2.	Angrisani L, Santonicola A, Iovino P, et al. IFSO Worldwide Survey 2016: primary, endoluminal, and revisional procedures. Obes Surg, 2018, 28(12): 3783-3794.
3.	郭沛, 刘朋朋, 侯栋升, 等. 腹腔镜袖状胃切除术治疗不同肥胖程度单纯性肥胖症的疗效分析. 中国普外基础与临床杂志, 2021, 28(2): 208-211.
4.	Woźniewska P, Diemieszczyk I, Hady HR. Complications associated with laparoscopic sleeve gastrectomy—a review. Prz Gastroenterol, 2021, 16(1): 5-9.
5.	马钰栋, 周爱明, 顾德智, 等. 腹腔镜袖状胃切除术后早期并发症的影响因素分析. 中国普外基础与临床杂志, 2023, 30(5): 582-586.
6.	Oshiro T, Wakamatsu K, Nabekura T, et al. Treatments for staple line leakage after laparoscopic sleeve gastrectomy. J Clin Med, 2023, 12(10): 3495. doi: 10.3390/jcm12103495.
7.	Al-Kurd A, Grinbaum R, Abubeih A, et al. Not all leaks are created equal: a comparison between leaks after sleeve gastrectomy and Roux-en-Y gastric bypass. Obes Surg, 2018, 28(12): 3775-3782.
8.	Sobhani Z, Moein Vaziri N, Hosseini B, et al. Late gastropleural fistula after the management of laparoscopic sleeve gastrectomy leakage. Obes Surg, 2020, 30(9): 3620-3623.
9.	Aljahdli ES, Aldabbagh A, Salah F, et al. Endoscopic management of post-laparoscopic sleeve gastrectomy leakage and stenosis using fully covered stent. Saudi J Med Med Sci, 2021, 9(1): 45-50.
10.	Iossa A, Abdelgawad M, Watkins BM, et al. Leaks after laparoscopic sleeve gastrectomy: overview of pathogenesis and risk factors. Langenbecks Arch Surg, 2016, 401(6): 757-766.
11.	Elariny H, González H, Wang B. Tissue thickness of human stomach measured on excised gastric specimens from obese patients. Surg Technol Int, 2005, 14: 119-124.
12.	Huang R, Gagner M. A thickness calibration device is needed to determine staple height and avoid leaks in laparoscopic sleeve gastrectomy. Obes Surg, 2015, 25(12): 2360-2367.
13.	Barski K, Binda A, Jaworski P, et al. Influence of preoperative weight loss on gastric wall thickness-analysis of laparoscopic sleeve gastrectomy histological material. Langenbecks Arch Surg, 2022, 407(8): 3315-3322.
14.	Susmallian S, Goitein D, Barnea R, et al. Correct evaluation of gastric wall thickness may support a change in staplers’ size when performing sleeve gastrectomy. Isr Med Assoc J, 2017, 19(6): 351-354.
15.	Rosenthal RJ, Diaz AA, et al. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12 000 cases. Surg Obes Relat Dis, 2012, 8(1): 8-19.
16.	Endo Y, Ohta M, Kawamura M, et al. Gastric wall thickness and linear staple height in sleeve gastrectomy in Japanese patients with obesity. Obes Surg, 2022, 32(2): 349-354.
17.	Barski K, Binda A, Kudlicka E, et al. Gastric wall thickness and stapling in laparoscopic sleeve gastrectomy—a literature review. Wideochir Inne Tech Maloinwazyjne, 2018, 13(1): 122-127.
18.	Gong S, Wang K, Li Y, et al. Ethnic group differences in obesity in Asian Americans in California, 2013–2014. BMC Public Health, 2021, 21(1): 1589. doi: 10.1186/s12889-021-11612-z.
19.	Rawlins L, Rawlins MP, Teel D. Human tissue thickness measurements from excised sleeve gastrectomy specimens. Surg Endosc, 2014, 28(3): 811-814.
20.	Boeker C, Mall J, Reetz C, et al. Laparoscopic sleeve gastrectomy: investigation of fundus wall thickness and staple height-an observational cohort study: fundus wall thickness and leaks. Obes Surg, 2017, 27(12): 3209-3214.
21.	van de Vrande S, Himpens J, El Mourad H, et al. Management of chronic proximal fistulas after sleeve gastrectomy by laparoscopic Roux-limb placement. Surg Obes Relat Dis, 2013, 9(6): 856-861.
22.	Lee YJ, Kim YN, Park S. Measurement of stomach wall thickness to guide staple selection during sleeve gastrectomy. Obes Surg, 2020, 30(6): 2140-2146.
23.	Abu-Ghanem Y, Meydan C, Segev L, et al. Gastric wall thickness and the choice of linear staples in laparoscopic sleeve gastrectomy: challenging conventional concepts. Obes Surg, 2017, 27(3): 837-843.
24.	Chekan E, Whelan RL. Surgical stapling device-tissue interactions: what surgeons need to know to improve patient outcomes. Med Devices (Auckl), 2014, 7: 305-318.

1. Debs T, Petrucciani N, Kassir R, et al. Laparoscopic conversion of sleeve gastrectomy to one anastomosis gastric bypass for weight loss failure: mid-term results. Obes Surg, 2020, 30(6): 2259-2265.
2. Angrisani L, Santonicola A, Iovino P, et al. IFSO Worldwide Survey 2016: primary, endoluminal, and revisional procedures. Obes Surg, 2018, 28(12): 3783-3794.
3. 郭沛, 刘朋朋, 侯栋升, 等. 腹腔镜袖状胃切除术治疗不同肥胖程度单纯性肥胖症的疗效分析. 中国普外基础与临床杂志, 2021, 28(2): 208-211.
4. Woźniewska P, Diemieszczyk I, Hady HR. Complications associated with laparoscopic sleeve gastrectomy—a review. Prz Gastroenterol, 2021, 16(1): 5-9.
5. 马钰栋, 周爱明, 顾德智, 等. 腹腔镜袖状胃切除术后早期并发症的影响因素分析. 中国普外基础与临床杂志, 2023, 30(5): 582-586.
6. Oshiro T, Wakamatsu K, Nabekura T, et al. Treatments for staple line leakage after laparoscopic sleeve gastrectomy. J Clin Med, 2023, 12(10): 3495. doi: 10.3390/jcm12103495.
7. Al-Kurd A, Grinbaum R, Abubeih A, et al. Not all leaks are created equal: a comparison between leaks after sleeve gastrectomy and Roux-en-Y gastric bypass. Obes Surg, 2018, 28(12): 3775-3782.
8. Sobhani Z, Moein Vaziri N, Hosseini B, et al. Late gastropleural fistula after the management of laparoscopic sleeve gastrectomy leakage. Obes Surg, 2020, 30(9): 3620-3623.
9. Aljahdli ES, Aldabbagh A, Salah F, et al. Endoscopic management of post-laparoscopic sleeve gastrectomy leakage and stenosis using fully covered stent. Saudi J Med Med Sci, 2021, 9(1): 45-50.
10. Iossa A, Abdelgawad M, Watkins BM, et al. Leaks after laparoscopic sleeve gastrectomy: overview of pathogenesis and risk factors. Langenbecks Arch Surg, 2016, 401(6): 757-766.
11. Elariny H, González H, Wang B. Tissue thickness of human stomach measured on excised gastric specimens from obese patients. Surg Technol Int, 2005, 14: 119-124.
12. Huang R, Gagner M. A thickness calibration device is needed to determine staple height and avoid leaks in laparoscopic sleeve gastrectomy. Obes Surg, 2015, 25(12): 2360-2367.
13. Barski K, Binda A, Jaworski P, et al. Influence of preoperative weight loss on gastric wall thickness-analysis of laparoscopic sleeve gastrectomy histological material. Langenbecks Arch Surg, 2022, 407(8): 3315-3322.
14. Susmallian S, Goitein D, Barnea R, et al. Correct evaluation of gastric wall thickness may support a change in staplers’ size when performing sleeve gastrectomy. Isr Med Assoc J, 2017, 19(6): 351-354.
15. Rosenthal RJ, Diaz AA, et al. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12 000 cases. Surg Obes Relat Dis, 2012, 8(1): 8-19.
16. Endo Y, Ohta M, Kawamura M, et al. Gastric wall thickness and linear staple height in sleeve gastrectomy in Japanese patients with obesity. Obes Surg, 2022, 32(2): 349-354.
17. Barski K, Binda A, Kudlicka E, et al. Gastric wall thickness and stapling in laparoscopic sleeve gastrectomy—a literature review. Wideochir Inne Tech Maloinwazyjne, 2018, 13(1): 122-127.
18. Gong S, Wang K, Li Y, et al. Ethnic group differences in obesity in Asian Americans in California, 2013–2014. BMC Public Health, 2021, 21(1): 1589. doi: 10.1186/s12889-021-11612-z.
19. Rawlins L, Rawlins MP, Teel D. Human tissue thickness measurements from excised sleeve gastrectomy specimens. Surg Endosc, 2014, 28(3): 811-814.
20. Boeker C, Mall J, Reetz C, et al. Laparoscopic sleeve gastrectomy: investigation of fundus wall thickness and staple height-an observational cohort study: fundus wall thickness and leaks. Obes Surg, 2017, 27(12): 3209-3214.
21. van de Vrande S, Himpens J, El Mourad H, et al. Management of chronic proximal fistulas after sleeve gastrectomy by laparoscopic Roux-limb placement. Surg Obes Relat Dis, 2013, 9(6): 856-861.
22. Lee YJ, Kim YN, Park S. Measurement of stomach wall thickness to guide staple selection during sleeve gastrectomy. Obes Surg, 2020, 30(6): 2140-2146.
23. Abu-Ghanem Y, Meydan C, Segev L, et al. Gastric wall thickness and the choice of linear staples in laparoscopic sleeve gastrectomy: challenging conventional concepts. Obes Surg, 2017, 27(3): 837-843.
24. Chekan E, Whelan RL. Surgical stapling device-tissue interactions: what surgeons need to know to improve patient outcomes. Med Devices (Auckl), 2014, 7: 305-318.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Measurement of gastric wall thickness following laparoscopic sleeve gastrectomy and analysis of its influencing factors

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