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

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

A Practical Strategy of Controlled Monopolar Cautery With/Without Oversewing for Staple Line Bleeding in Bariatric Surgery: A Single Center Experience

Introduction In laparoscopic bariatric surgery, stapling devices are essential for creating a gastric tube or gastric pouch. Staple line bleeding (SLB) is an important issue, but the effect of monopolar cautery for SLB control is unclear. This study aimed to evaluate the outcomes of controlled monopolar cautery with/without oversewing for SLB control during bariatric surgery. Materials and Methods From January 2019 to May 2021, 66 patients underwent bariatric surgery with controlled monopolar cautery with/without oversewing for SLB control. Patient demographics and intraoperative and postoperative outcomes were analyzed. Results This study enrolled 35 women and 31 men (mean age: 38.1 years; mean body mass index: 39.8 kg/m2). All patients had varying degrees of SLB. Controlled monopolar cautery was applied to 63 patients with ≤6 bleeding sites. Only two patients needed further partial oversewing of the bleeding sites after controlled monopolar cautery failed to achieve hemostasis. Initially, three patients had more than six bleeding sites, and thus complete oversewing was performed to achieve successful hemostasis. There was no intraabdominal or gastrointestinal bleeding. There were one gastric stricture, one anastomotic leakage, and one staple line leakage. Conclusions The strategy of controlled monopolar cautery with/without oversewing is a simple, practical, inexpensive, and safe method for SLB control during bariatric surgery.

Esophageal Perforation After Laparoscopic Sleeve Gastrectomy and Paraesophageal Hernia Repair Managed by Transhiatal Drainage

Laparoscopic sleeve gastrectomy (SG) was first established as a 2-stage procedure in high-risk patients undergoing gastric bypass or biliary pancreatic diversion with duodenal switch. It has since become increasingly used as a primary bariatric procedure. The 2 significant postoperative complications after this procedure are anastomotic staple line leakage or bleeding. True esophageal leaks after sleeve gastrectomy are extremely uncommon. We present a case of contained esophageal perforation after a laparoscopic sleeve gastrectomy and paraesophageal hernia repair managed successfully with laparoscopic-assisted transhiatal drainage. We review the literature on the management of this uncommon but highly morbid complication in patients undergoing bariatric surgery.