Comparison of Bariatric Protocols in Laparoscopic Sleeve Gastrectomy: A Retrospective Analysis on Patient Outcomes

Background: More than 250,000 laparoscopic sleeve gastrectomy (LSG) are performed annually accounting for about 61.4% of all bariatric procedures. The national average cost for LSG ranges between $15,000 and 33,000 with an estimated economic impact of $7.5 billion yearly in the United States alone, expenditures are likely to continue increasing steadily. LSG has already emerged as the preferred surgical choice for obesity. Materials and Methods: Retrospective review of 198 patients who underwent LSG. Among the several clinical parameters collected, the pertinent ones were length of stay (LOS) after LSG, operative time, anesthesia time, complications, readmissions, radiation exposure, economic impact between those who underwent intraoperative esophagogastroduodenoscopy (IEGD) and postoperative upper gastrointestinal series (PUGI). Results: LOS was significantly different with mean difference of 1.835 ± 0.8645 days (confidence interval [95% CI]: 0.1298-3.540) and p-value of 0.0351, mean LOS in IEGD was 1.088 and PUGI 2.923 days. Time to initiation of diet - mean difference 16.50 ± 0.9250 h (95% CI: 14.68-18.33), p-value of <0.0001. Radiation exposure in IEGD was nil, whereas in PUGI Fluro time was 6-78 s, mean time 26.73 s, standard deviation 19.69. Procedural and anesthesia times with a mean of 66.05 min and 109.7 min respectively, and p-value of 0.0174 and 0.0182 both being significantly different. There was no statistical significance between the groups for complications, emergency department visits, and readmissions. Conclusions: Our study clearly illustrates that IEGD is superior to PUGI on several parameters. This translates into increased efficiency, reduced economic burden, decreased hospital LOS, radiation exposure, and increased overall patient satisfaction.