Staple line reinforcement during laparoscopic sleeve gastrectomy: pros and cons

Background: Nowadays, laparoscopic sleeve gastrectomy (LSG) is the most common performed bariatric procedure. Staple line reinforcement (SLR) advised for reducing gastric leaks and bleeding after LSG. The aim of this study is to evaluate the efficacy of SLR in reducing the postoperative complications compared to non-SLR during LSG.Method: Sixty morbid obese patients were scheduled for LSG in this prospective randomized study at Sohag University Hospital in the period between March 2016 to February 2018. Patients were divided randomly into two groups: Group I included 30 patients underwent LSG with over sewing of the staple line with running suture using VLoc™ V 3/0 suture. Group II underwent LSG without SLR (n=30).Results: No cases with leaks or stenosis were detected in our series. The operative time was significantly longer in the SLR group compared to the non-SLR group (125 (110-160) vs 100 (90-125) minutes respectively, p<0.01). Staple line bleeding was detected postoperatively only in one case in group II (3.3%) which was treated conservatively. The length of hospital stay was longer in the non-reinforcement group but not significantly different (p=0.25).Conclusions: Staple line reinforcement during LSG has no superiority on the outcome of this operation, used by surgeons as a personal preference and as a security shield rather than for its advantages.

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Outcome of over-sewing reinforcement of gastric staple line during laparoscopic sleeve gastrectomy in morbid obese patients: single center experience

International Surgery Journal ◽

10.18203/2349-2902.isj20180818 ◽

2018 ◽

Vol 5 (3) ◽

pp. 991

Author(s):

Adel M. Abdallah

Keyword(s):

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

Staple Line ◽

Low Cost ◽

Controlled Study ◽

Staple Line Reinforcement ◽

Single Center Experience ◽

Group I ◽

Morbid Obese ◽

Group Ii

Background: During laparoscopic sleeve gastrectomy (LSG), different staple line reinforcement techniques are adopted by many bariatric surgeons, aiming at reducing the incidence of bleeding and leakage from the staple line.Methods: Fifty patients suffering from morbid obesity with body mass index above 35kg/m2 were prepared for LSG. The patients were enrolled in a prospective, randomized controlled study comparing the effect of staple line reinforcement by suture over-sewing versus non-reinforcement. Patients were classified randomly into two groups. In group I, after gastric stapling, the staple line was reinforced by suture over-sewing using continuous extra-serosal invaginating absorbable polyglycol sutures. In group II (non-reinforcement group), staple line over clipping by 10 mm clips was used when needed.Results: Three cases (12%) in group II presented with collected hematomas and staple line bleeding necessitated laparoscopic evacuation and staple line bleeding control by suture over-sewing or additional clipping. In group I, one case (4%) of hematoma responded well to per-cutaneous drainage. There were 2 cases of leakage (8%) in group II versus no detectable cases in group I. Stenosis was detected in one case (4%) in group II while no detected cases in group I. The operative duration was 135 minutes in group II versus 110 minutes in group I.Conclusions: Reinforcement by suture over-sewing of the staple line as a step in LSG is a safe, technically easy, of low cost and can reduce the incidence of postoperative complications as bleeding and leakage although it significantly prolongs the operative time.

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A prospective randomized study on staple line reinforcement during laparoscopic sleeve gastrectomy: fibrin glue, Ifabond or none?

Chirurgia ◽

10.23736/s0394-9508.18.04786-1 ◽

2018 ◽

Vol 31 (6) ◽

Author(s):

Sinan Binboga ◽

Hakan Seyit ◽

Elif Binboga ◽

Pinar Kasapoglu ◽

Osman Kones ◽

...

Keyword(s):

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

Fibrin Glue ◽

Staple Line ◽

Randomized Study ◽

Prospective Randomized Study ◽

Staple Line Reinforcement

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Staple Line Reinforcement During Laparoscopic Sleeve Gastrectomy: Absorbable Monofilament, Barbed Suture, Fibrin Glue, or Nothing? Results of a Prospective Randomized Study

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-015-2999-5 ◽

2015 ◽

Vol 20 (2) ◽

pp. 361-366 ◽

Cited By ~ 22

Author(s):

S. Carandina ◽

M. Tabbara ◽

M. Bossi ◽

A. Valenti ◽

C. Polliand ◽

...

Keyword(s):

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

Fibrin Glue ◽

Staple Line ◽

Randomized Study ◽

Prospective Randomized Study ◽

Barbed Suture ◽

Staple Line Reinforcement

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Impact of Gastropexy/Omentopexy on Gastrointestinal Symptoms after Laparoscopic Sleeve Gastrectomy

Obesity Surgery ◽

10.1007/s11695-021-05806-y ◽

2021 ◽

Author(s):

Hady Saleh Abou-Ashour

Keyword(s):

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

Hospital Readmissions ◽

Randomized Study ◽

Gastrointestinal Symptoms ◽

Length Of Hospital Stay ◽

Single Step ◽

University Hospital ◽

Reflux Symptoms ◽

Significant Difference

Abstract Background Laparoscopic sleeve gastrectomy (LSG) has become a single-step operation for the management of severe obesity. A statistically significant number of participants who undergo this procedure experience nausea, vomiting, and reflux symptoms early after the operation. The objectives of this study were to measure the positive or negative effect of gastropexy on reducing distressing postoperative LSG-related gastrointestinal symptoms. Patients and Methods This was a comparative randomized study conducted from January 2018 to January 2021. The study was carried out in the general surgery department at Menoufia University Hospital, Menoufia Faculty of Medicine in Egypt. Two hundred participants were included randomly during this trial. The participants were divided into two groups, with 100 patients in each group. Patients in group A underwent gastropexy, and patients in group B underwent LSG without gastropexy. Results There was no significant difference between the groups in age or sex (p > 0.05). There was no significant difference in the length of hospital stay (p > 0.05). There was a significant difference between the two groups regarding nausea, vomiting, reflux symptoms, and the amount and frequency of antiemetics used (p < 0.001). There was also a significant difference in hospital readmissions (p < 0.05) and in clinic visits during the postoperative period. Conclusions Patients who underwent gastropexy showed a significant reduction in antiemetic consumption and a significantly lower incidence of postoperative nausea, vomiting, gastroesophageal reflux disease symptoms and gastric torsion than those who did not undergo gastropexy. Graphical abstract

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