Technical variability and safety of sleeve gastrectomy: a nationwide survey of bariatric centers in Poland

TL;DR

A survey of bariatric centers in Poland shows that sleeve gastrectomy is generally safe but has varying techniques that could affect outcomes.

Contribution

This study provides a nationwide analysis of sleeve gastrectomy practices and complication rates in Poland, highlighting variability and safety trends.

Findings

70% of centers used 36 French calibration bougies for sleeve gastrectomy.

Complication rates were low (e.g., 0.33% leak rate) but varied between high- and low-volume centers.

84.3% of centers performed leak tests, while drain placement was omitted in 66.7% of cases.

Abstract

Sleeve gastrectomy (SG) is the most frequently performed bariatric procedure in Poland. While considered technically straightforward, significant variation exists in the operative technique, which may affect safety outcomes.

This study aimed to analyze the technical aspects and complication rates of SG across Polish bariatric centers in 2023.

This is a secondary analysis of a nationwide survey conducted among bariatric centers affiliated with the Metabolic and Bariatric Surgery Chapter of the Association of Polish Surgeons. As many as 54 centers participated, reporting detailed data on SG technique and outcomes. The centers were stratified by annual SG volume using a 50-procedure threshold, corresponding to the suggested learning curve.

A total of 7450 SG procedures were reported. Calibration bougies of 36 French were used by 70% of the centers. Staple line reinforcement was routinely performed in 72.5% of the centers, with oversewing and clipping as the most common methods. Leak tests were performed by 84.3% of the centers, while 66.7% omitted routine drain placement. Postoperative complication rates included bleeding (0.98%), leak (0.33%), reoperation (1.04%), and mortality (0.16%). Although not significant, complication rates were consistently higher in the centers performing fewer than 50 SGs annually.

SG in Poland is characterized by favorable safety outcomes but notable procedural variability. While most centers follow recommended practices, a lack of standardization persists in key technical areas. Surgical volume may influence complication rates. National guidelines and structured training programs may help harmonize practice and improve outcomes.