Publication/Presentation Date

7-31-2015

Abstract

ViSiGi 3D™ vs. Bougie Dilator for Sleeve Gastrectomy Calibration

Nicholas Schiavone1

Richard Boorse M.D.1,2

1Department of Surgery, Lehigh Valley Health Network

2Research Scholar Program Mentor

Abstract

This paper is the start of a quality improvement project to decrease cost, length of stay, and various problems that are uncommon, but known to happen with laparoscopic sleeve gastrectomies. This will be accomplished by comparing the standard bougie used in laparoscopic sleeve gastrectomies with a newer technology called the ViSiGi 3DTM which is a suction calibration system. A database has been completed that tracks patient information and various important details from surgery to discharge that will allow for analysis of pros and cons of each calibration device pending approval from the IRB.


Background

Bariatric surgical procedures are rapidly becoming the most performed in the field of general surgery. Specifically the laproscopic sleeve gastrectomy is gaining popularity as an effective weight loss tool. Laparoscopic sleeve gastrectomy involves resection of 70% of the stomach leaving a narrow tube referred to as a “sleeve” (Fig. 1). The sleeve gastrectomy helps patients lose weight in two ways: the first being restricting volume of oral intake and the second being reduction in the “hunger hormone” ghrelin by removal of the gastric fundus where the hormone is produced. There are several important tools used in the completion of a laparoscopic sleeve gastrectomy, and this paper will focus on only one of them, the bougie. The bougie is plastic tubing that is inserted by the anesthetist through the mouth, down the esophagus, and rests against the pyloric sphincter in the stomach. This is then used as a guide for the surgeon to staple alongside of and form the new sleeve. The problem with a traditional weighted bougie (Fig. 2) is that the anesthetist needs to continually adjust and readjust the bougie so that the sleeve is uniform in shape and size. We started using a ViSiGi 3D calibration device (Fig. 3) and are planning to compare the results with those of a standard bougie. The advantages of a ViSiGi 3D calibration device are that not only does it serve the purpose of the standard bougie, it also compresses the stomach uniformly due to the suction acting on all surfaces of the stomach equally, it empties the stomach of all contents, as well as holding the stomach in place which removes the need for constant readjustment. The aim of this paper is to discuss the database that was created, and the process that was used to create it that will be used to compare and contrast the ViSiGi 3D calibration device to the standard weighted bougie.

Methodology

This study will be a retrospective chart review that will be broken up into two cohorts. The first cohort is comprised of the 100 sleeve gastrectomy cases preceding the use of the ViSiGi 3D suction calibration system in which a weighted bougie was used. The second cohort consisted of the first 100 sleeve gastrectomy cases using the ViSiGi 3D system. Both cohorts had procedures that were either stand-alone sleeve gastrectomies or a conversion of a band to a sleeve. All of the procedures were performed by either Dr. Boorse or Dr. Harrison using nearly identical techniques. Dispersed throughout these procedures were additional surgeries completed such as cholecystectomy, hiatal hernia repair, umbilical hernia repair, and/or lysis of adhesions which will be taken into consideration when determining the length of procedure. The first step in completing this project, following the completion of the 200 cases, was to make a database that outlined all the variables of interest, of which there were 110. These are listed in table 1. The importance of these variables is twofold. The first is that it will allow us, once we receive IRB approval, to analyze the data points which are truly important to our future paper. The second is that it has already allowed us to create an entire bariatric database that will be used to gather important data points on all future bariatric procedures performed at LVHN and will allow for continuous quality improvement analysis that is not limited to only laparoscopic sleeve gastrectomies. That data used in the database was gathered using a combination of EHMR as well as the newly implemented system of EPIC Hyperspace.

Results

There are no results at this time because the database has not yet been analyzed due to all the criteria not being fully collected at the time that this paper was written.

Discussion

However, there are several early impressions that the surgeons have made since using the ViSiGi 3d suction calibration system that we will be expecting to be confirmed once statistical analysis is performed. The first is a decrease in staple load fires. The second is that, due to the diminished need to constantly readjust the bougie, the overall length of procedure will decrease. The third is that leakage rates will be decreased. The fourth is that the overall length of stay will decrease. The fifth is that the rate of 30 day readmissions will decrease. We are hoping that, due to the aforementioned benefits, the cost will decrease more than the additional cost of the ViSiGi 3D. If any of the above is true the ViSiGi 3D may be made the new standard of care in the LVHN hospital network.

Conclusion

The goal of this paper was to give background on the differences between the standard bougie and the ViSiGi 3D suction calibration system, outline the database being used for storage of vital information pertaining to future quality improvement projects, as well as outline the goal for any future quality improvement projects that will be performed once all data has been collected. This paper is a promising start to a strong quality improvement project using the ViSiGi 3D suction calibration system during laparoscopic sleeve gastrectomies. It also provides the groundwork in the form of an all-encompassing bariatric database that will be used to compare all procedural outcomes with one another rather than just sleeve to sleeve comparisons. The future aim of Dr. Boorse and his colleagues is to statistically evaluate the pros and cons, if any, of using the ViSiGi 3D suction calibration system versus a standard bougie.

Appendix

Last Name

First Name

Date of Birth

Medical Record Number

Encounter Number

Age

Race

Sex

Smoking Status

Pre Op Weight

Pre Op BMI

History of Pulmonary Embolism

History of Deep Vein Thrombosis

Cholelithiasis/Previous Cholecystectomy

Sleep Apnea

Diabetes Mellitus

If “Yes” Type 1 or 2

Gastro Esophageal Reflux Disease

Hypertension

Hyperlipidemia

Cardiac Disease

Chronic Anticoagulation Meds

Myocardial Infarction

Musculoskeletal problems (i.e. arthritis, disc disease, or both)

Anxiety

Depression

Barrett’s Esophagus

Pre Op Hpylori Result

EGD Result of Hiatal Hernia

Surgery Date

What Procedure

The surgeon which performed the procedure

Whether a ViSiGi bougie was used

If “yes” what size

Whether a Standard Bougie was used

If “yes” what size

How many of each staple was fired

White, Blue, Green, Gold, Black

Cost of Surgery

Length of the Procedure

What additional surgeries the patient had

Cholecystectomy, hiatal hernia repair, umbilical hernia repair, and/or lysis of adhesions

Admit Date

Discharge Date

Length of Stay

If the length of stay was greater than 36 hours what was the reason

Nausea, Fever, PO intolerance, Urinary Retention, Bleeding, and/or Other

If an upper GI was performed

If “yes” what were the findings

Leak, Obstruction, Stricture, or Normal

If the patient was readmitted within 30 days

If “yes” what was the reason

Nausea Vomiting, Dehydration, Superficial Site Infection, Deep Site Infection, Leak, Diarrhea, Respiration Failure, Pneumonia, Incisional Hernia, Deep Vein Thrombosis, C-Diff, Intestinal Obstruction, Stricture, Bleeding, Pain, Anastomotic Ulcer, Biliary Disease, and/or Other

What was the weight lost at each successive post op visit?

First initial, 1 month, 3 month, 6 month, 1 year, 2 year, 3 year, 4 year, and 5 year

Comorbidity resolution

I.e. Diabetes Mellitus, Hypertension, etc.

If cholelithiasis developed post operatively what was the date it was diagnosed

Intraoperative complications

Conversion from laparoscopic to open

What was the reason if there was one?

Mortality

If “yes” how soon after the surgery

What was the cause?

Figure 1. Diagram of sleeve gastrectomy

Figure 2. example of standard weighted bougie dilator

Figure 3. ViSiGi 3D suction calibration system

Comments

Mentor: Richard Boorse, MD

Department(s)

Research Scholars (Acknowledgements and Co-authored Publications), Research Scholars - Posters, Department of Surgery, Department of Surgery Faculty, Patient Care Services / Nursing

Document Type

Poster

Additional Files
Schmidt - Manuscript.pdf (349 kB)
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