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To oversew or not to oversew in robotic sleeve gastrectomy: a case against oversewing the staple line

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Abstract

Background

The benefits of oversewing the staple lines during laparoscopic sleeve gastrectomy have been controversial. No study examined the benefit of oversewing the staple lines in robotic sleeve gastrectomy (RSG). This retrospective study aims to examine the difference in immediate postoperative complications, readmissions, reoperations, and emergency room visits between RSG patients with and without oversewn staple lines at a single, large-volume, bariatric center.

Methods

A retrospective chart review was conducted on 623 patients who underwent RSG between November 1, 2017, and November 1, 2019. Of these, 316 had their staple line oversewn between November 1, 2017, and November 12, 2018, and 307 did not have their staple line oversewn between November 13, 2018, and November 1, 2019.

Results

A total of 623 patients underwent RSG, of which 50.7% (n = 316) had their staple line oversewn. The mean length of hospital stay was similar between the two groups. However, the mean operative time was significantly longer in the “oversew” group than “no oversew” group by 7.4 minutes (p < 0.001). Readmission, reoperation, and intervention rates during the 30-day postoperative period were similar between the two groups. However, the percentage of patients requiring outpatient emergency room visits during the 30 days after RSG was significantly higher in the “oversew” group than that of the “no oversew” group.

Conclusions

No significant difference in major complications was found between RSG patients with and without oversewn staple lines. Oversewing of the staple line may be associated with increased emergency room visits.

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References

  1. Buchwald H, Oien DM (2013) Metabolic/bariatric surgery worldwide 2011. Obes Surg 23(4):427–436

    Article  Google Scholar 

  2. Brethauer SA, Hammel JP, Schauer PR (2009) Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis 5(4):469–475

    Article  Google Scholar 

  3. Kruger RS, Pricolo VE, Streeter TT, Colacchio DA, Andrade UA (2014) A bariatric surgery center of excellence: operative trends and long-term outcomes. J Am Coll Surg 218(6):1163–1174

    Article  Google Scholar 

  4. Gagner M, Deitel M, Erickson AL, Crosby RD (2013) Survey on laparoscopic sleeve gastrectomy (LSG) at the Fourth International Consensus Summit on Sleeve Gastrectomy. Obes Surg 23(12):2013–2017

    Article  Google Scholar 

  5. Garofalo F, Noreau-Nguyen M, Denis R, Atlas H, Garneau P, Pescarus R (2017) Evolution of endoscopic treatment of sleeve gastrectomy leaks: from partially covered to long, fully covered stents. Surg Obes Relat Dis 13(6):925–932

    Article  Google Scholar 

  6. Wang H, Lu J, Feng J, Wang Z (2017) Staple line oversewing during laparoscopic sleeve gastrectomy. Ann R Coll Surg Engl 99(7):509–514

    Article  CAS  Google Scholar 

  7. Zafar SN, Felton J, Miller K, Wise ES, Kligman M (2018) Staple line treatment and bleeding after laparoscopic sleeve gastrectomy. JSLS 22(4):e2018.00056

  8. Moon R, Teixeira A, Varnadore S, Potenza K, Jawad MA (2013) Reinforcing the staple line with Surgicel(R) Nu-knit(R) in Roux-en-Y gastric bypass: comparison with bovine pericardial strips. Obes Surg 23(6):788–793

    Article  Google Scholar 

  9. Choi YY, Bae J, Hur KY, Choi D, Kim YJ (2012) Reinforcing the staple line during laparoscopic sleeve gastrectomy: does it have advantages? A meta-analysis. Obes Surg 22(8):1206–1213

    Article  Google Scholar 

  10. Hany M, Ibrahim M (2018) Comparison between stable line reinforcement by barbed suture and non-reinforcement in sleeve gastrectomy: a randomized prospective controlled study. Obes Surg 28(8):2157–2164

    Article  Google Scholar 

  11. Ser KH, Lee WJ, Lee YC, Chen JC, Su YH, Chen SC (2010) Experience in laparoscopic sleeve gastrectomy for morbidly obese Taiwanese: staple-line reinforcement is important for preventing leakage. Surg Endosc 24(9):2253–2259

    Article  Google Scholar 

  12. Gagner M, Kemmeter P (2020) Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review. Surg Endosc 34(1):396–407

    Article  Google Scholar 

  13. Taha O, Abdelaal M, Talaat M, Abozeid M (2018) A randomized comparison between staple-line oversewing versus no reinforcement during laparoscopic vertical sleeve gastrectomy. Obes Surg 28(1):218–225

    Article  Google Scholar 

  14. Mocanu V, Dang J, Ladak F, Switzer N, Birch DW, Karmali S (2019) Predictors and outcomes of bleed after sleeve gastrectomy: an analysis of the MBSAQIP data registry. Surg Obes Relat Dis 15(10):1675–1681

    Article  Google Scholar 

  15. Musella M, Milone M, Bellini M, Leongito M, Guarino R, Milone F (2011) Laparoscopic sleeve gastrectomy. Do we need to oversew the staple line? Ann Ital Chir 82(4):273–277

    PubMed  Google Scholar 

  16. Kassir R, Debs T, Blanc P et al (2016) Complications of bariatric surgery: presentation and emergency management. Int J Surg 27:77–81

    Article  Google Scholar 

  17. Ruiz-Tovar J, Zubiaga L, Muñoz JL, Llavero C (2018 Nov) Incidence of postoperative nausea and vomiting after laparoscopic sleeve gastrectomy with staple line reinforcement with oversewing and staple line inversion vs buttressing material: A randomized clinical trial. Int J Surg 59:75–79. https://doi.org/10.1016/j.ijsu.2018.09.010

    Article  PubMed  Google Scholar 

  18. Guerrier JB, Mehaffey JH, Schirmer BD, Hallowell PT (2018) Reinforcement of the staple line during gastric sleeve: a comparison of buttressing or oversewing, versus no reinforcement- a single-institution study. Am Surg 84(5):690–694

    Article  Google Scholar 

Download references

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Authors and Affiliations

  1. Orlando Health Weight Loss and Bariatric Surgery Institute, Orlando Health, 89 W Copeland Dr, 1st Floor, Orlando, FL, USA

    Rena C. Moon, Andre F. Teixeira & Muhammad A. Jawad

Authors
  1. Rena C. Moon
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  2. Andre F. Teixeira
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  3. Muhammad A. Jawad
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Correspondence to Muhammad A. Jawad.

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Moon, R.C., Teixeira, A.F. & Jawad, M.A. To oversew or not to oversew in robotic sleeve gastrectomy: a case against oversewing the staple line. Langenbecks Arch Surg 406, 1023–1027 (2021). https://doi.org/10.1007/s00423-020-02073-w

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  • DOI: https://doi.org/10.1007/s00423-020-02073-w

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