In Laparoscopic Sleeve Gastrectomy (LSG), a bougie is inserted into the stomach to allow for a standardised gastric remnant. There is no general agreement on the size of this bougie or its influence on drinking capacity over time. This may have implications for employment in hot areas or vocations where patients are at risk of dehydration.
Aim:
This, prospective, non-randomised observational trial, examines changes in fluid tolerance to develop a benchmark for fluid intake post LSG and identify differences in 36 and 40Fr cohorts.
Method:
240 patients who have undergone 36Fr or 40Fr LSG. Patients were provided with a 1L bottle and instructed to drink as much standard fluid (room temperature tap water) as possible over a 2 hour period at the eight week, as well as the three, six and twelve month marks post-surgery. Patients were directed to drink to their subjective report of ‘feeling full and unable to drink any more’, using a Likert Scale.
Results:
Of 240 patients who initially enrolled, 152 have completed at least one tolerance assessment (study ongoing). N = 100 36Fr, 52 40Fr, 139 primary surgeries and 13 revisions ( 10/52 in 40fr cohort). 11.25% have now completed all phases of the study. The maximum tolerated volumes at 1 and 2hrs increased significantly over time and averaged 863 (36Fr) and 868 (40Fr) mLs/hr by 12 months. There were no differences between median or average intake at any time point for the two bougie sizes. A capacity of 800mls /hr was achieved in both groups by 3 months.
Discussion:
These results will change our preference or concerns about using the slimmer 36fr bougie for patients working in a hot environment. They confirm that drinking capacity increases over time and should achieve volumes commensurate with safe workplace targets.