Comparison of Staple-Line Leakage and Hemorrhage in Patients Undergoing Laparoscopic Sleeve Gastrectomy with or Without Seamguard

Laparoscopic sleeve gastrectomy (LSG) has been recognized as a primary procedure for the surgical management of morbid obesity. Staple-line leaks and hemorrhage are two associated complications. Staple-line buttressing materials have been suggested to decrease these complications. When used during LSG, few published papers exist that compare the incidence of leak or hemorrhage to that of nonreinforced staple-lines. The purpose of this study was to compare the incidence of leak and hemorrhage in patients who did and did not receive reinforcement with Seamguard (W.L. Gore & Associates, Flagstaff, AZ). This is a retrospective analysis of patients undergoing LSG. All patients met National Institutes of Health criteria and each had an extensive preoperative evaluation. Data was collected from inpatient and outpatient medical records. Fifty-nine patients received reinforcement and 80 patients did not. There was no significant difference in mean body mass index, age, or gender make-up between the two groups. The overall incidence of leak was 3.60 per cent. The incidence was 3.39 per cent in patients who received reinforcement and 3.75 per cent in those who did not. This was not statistically significant. There was no incidence of staple-line hemorrhage in either group. There is no conclusive evidence that Seamguard reduces staple-line leakage or hemorrhage. Studies involving a larger number of patients are necessary before recommending staple-line reinforcement.

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The Effect of the Cartridge Used in Laparoscopic Sleeve Gastrectomy on the Development of a Staple-Line Leak

The American Surgeon ◽

10.1177/000313481808400958 ◽

2018 ◽

Vol 84 (9) ◽

pp. 1499-1503 ◽

Cited By ~ 2

Author(s):

Serhan Derici ◽

Koray Atila ◽

Seymen Bora

Keyword(s):

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

Staple Line ◽

Surgical Techniques ◽

Median Number ◽

University Hospital ◽

Tissue Thickness ◽

Significant Difference ◽

Staple Line Leaks

Morbid obesity surgery has increased by 450 per cent in the past decade. Preferred surgical techniques have also changed, and since 2014, the most common surgical procedure worldwide has been laparoscopic sleeve gastrectomy (LSG). The most serious complication of this surgery is staple-line leaks, which leads to significant increases in cost and a considerable rate of mortality. This study aimed to investigate the effects of staples used in LSG on the development of staple-line leaks. The sample of the study comprised 70 patients that consecutively underwent surgery at Dokuz Eylül University Hospital between March 2014 and June 2015. The patients were divided into two equal groups. For the first group, resection was performed using blue-green EndoGIA™ cartridges (BGC) (Medtronic, Norwalk, CT). In the other group, purple Tri-Staple™ cartridges (TSC) (Medtronic) were used. To examine the effect of the cartridge type, the point and pressure of leak was determined from fresh specimens following saline infusion. No statistically significant difference was found between the two groups in terms of mean age, body mass index, gender distribution or comorbidity. The median number of cartridges used was five in both groups. The resistance of the staple line to intragastric pressure was found to be significantly higher in the TSC group compared with the BGC group [51.94 (618.34) mmHg and 39.77 (617.09) mmHg, respectively, P = 0.005]. Most applications undertaken to reduce the risk of leak development in LSG aim to reinforce the staple line. There are very few studies that investigated the quality of staple line, and none examined the effect of staple cartridges on the development of leaks. Therefore, we conducted this study to fill this gap in the literature. The results revealed that tissue thickness cartridge compatibility had a role in the development of leaks during the resection of gastric tissue in which the thickness is reduced from the distal to the proximal portion. We conclude that during vertical sleeve gastrectomy, using TSC that are compatible with a wider range of tissue thickness results in more durable staple lines than EndoGIA™ cartridges.

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Is Staple LRE to Prevent Post-Operative Staple Line Leak and Haemorrhage after Laparoscopic Sleeve Gastrectomy

10.53350/pjmhs2115113028 ◽

2021 ◽

Vol 15 (11) ◽

pp. 3028-3029

Author(s):

Junaid Khan Lodhi ◽

Aasim Malik ◽

Saba Tahir Bokhari ◽

Saima Amjad ◽

Muhammad Zubair ◽

...

Keyword(s):

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

Staple Line ◽

Operation Time ◽

P Value ◽

Staple Line Reinforcement ◽

Postoperative Leak ◽

Added Benefit ◽

Staple Line Leakage ◽

Group 2

Background: Staple line haemorrhage and leak are considered to be common complications of laparoscopic sleeve gastrectomy. Some strongly recommend staple line reinforcement to deal with these complications while some consider it non beneficial. Aim: To analyze if staple line reinforcement is essential to prevent staple line haemorrhage and leaks. Methods: This retrospective study was conducted in Surgical unit 1 Fatima Memorial Hospital. A total of 100 patients were selected and divided into two groups of 50 each. Group 1 had staple line reinforced while group 2 had no reinforcement at all. All patients were observed for 24-48 hours for post-operative bleeding and leak. Results: Staple line leakage was found to be 4% in patients with staple line reinforcement whereas it was 6% in patients without staple line reinforcement with a p value of 0.284 which was not significant. Likewise, staple line bleeding in both groups were 2% and 6% with p value of 0.129 which was also insignificant. Conclusion: There is no added benefit to reinforce the staple line to prevent postoperative leak or bleeding but reinforcement only prolongs the operation time. Keywords: Laparoscopic sleeve gastrectomy, leak, post-operative bleeding, staple line reinforcement

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