The Effect of Transoral Gastric Remnant Extraction on Prescription Opioid Refills and Surgical Site Infections in Patients Undergoing Sleeve Gastrectomy

Background: This review examines opioid prescription refills and postoperative surgical site infection (SSI) rates associated with two forms of gastric remnant extraction during sleeve gastrectomy (SG). Methods: SG was performed on n = 148 consecutive patients. The transabdominal remnant extraction (TARE) group consisted of 75/148 patients (50.7%), while 73/148 patients (49.3%) underwent transoral remnant extraction (TORE). Technique varied only in method of remnant extraction. Results: The TORE cohort incidence of diabetes mellitus was significantly higher at 35/72 (48.6%) compared with 17/73 (23.3%) for the TARE cohort (p ≤ 0.0018). Mean body mass index was similar between TARE (42.81 kg/m², standard deviation [SD] = 7.156) and TORE (43.00 kg/m², SD = 5.99). The number of patients who requested ≥1 opioid refill was 24/73 (32.9%) with TARE compared to 12/72 (16.7%) with TORE (p = 0.03382). SSI developed in 3/75 (4.0%) TARE patients and only 1/73 (1.4%) of TORE patients (OR = 3.0, p = 0.6404 NS). Conclusion: These data suggest that patients undergoing SG obtained significantly fewer opioid refills when the gastric remnant was removed transorally. SSIs also trended lower in the transoral extraction group. Implementation of transoral specimen extraction may be an adjunct to decrease opioid refills and is associated with similar surgical outcomes when compared with traditional transabdominal extraction.