The Utility of Intraoperative Endoscopy to Assist Novice Surgeons in the Detection of Gastric Stenosis during Laparoscopic Sleeve Gastrectomy

Laparoscopic sleeve gastrectomy (LSG) is a commonly performed bariatric surgery, but is associated with gastric stenosis and leaks. Herein, we report our experience of intraoperative endoscopy (IOE) to evaluate stenosis and leaks during LSG. LSG was performed by three surgeons. Patients who underwent LSG and IOE between January 2016 and March 2020 were enrolled and assigned to two groups: group 1 (1 st -30 th LSG case for each surgeon) and group 2 (>30 th LSG for each surgeon). Patients’ anthropometric and biochemical data pre- and post-LSG, as well as IOE findings and follow-up esophagogastroduodenoscopy records were reviewed. In total, 352 patients were enrolled including 90 patients in group 1 and 262 patients in group 2. Three out of 352 patients (0.9%) were found to have stenosis by IOE, which was related to tightly gastropexy stitch or reinforcement stitch, all of which were in group 1. Stenosis was resolved after removal of the stitch during LSG. The incidence of gastric stenosis detected by IOE was 3.3% (3/90) and 0% (0/262) in group 1 and group 2, respectively ( P =0.003). No leakage was found in this study and no patient developed clinical or endoscopic stenosis after LSG. In conclusion, IOE can help detect gastric stenosis during LSG, especially for novice surgeons, and the stenosis could be resolved during operation.