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Comparison of Reinforcement Techniques Using Suture on Staple-Line in Sleeve Gastrectomy

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Abstract

Background

Sleeve gastrectomy is a common procedure in recent years for treatment of morbid obesity however leak from staple-line is its main challenging complication. Despite numerous studies regarding leak after sleeve gastrectomy, there is still no conclusion on reinforcement of staple-line in this procedure. The purpose of this study was to compare two methods of oversewing staple-line versus no reinforcement.

Methods

Resected stomachs of 30 patients undergoing laparoscopic sleeve gastrectomy were evaluated for bursting pressure immediately after extraction from the abdomen. Reinforcement technique was applied in random order to 3 segments of the staple-line on each specimen: continuous Lembert’s sutures, continuous through-and-through sutures, and no reinforcement. Bursting pressure was determined by injection of methylene blue solution into lumen of resected stomach and recording pressure at which leakage occurs. Location of leak, intragastric pressure, and volume at first leak were recorded.

Results

Baseline characteristics of patients were similar in randomized groups for order of reinforcement technique. Mean ischemia time of specimens was 17.4 ± 10.4 min. No leaks were observed in segments reinforced with Lembert’s oversewing technique. The through-and-through reinforcement segments were first to leak in 21 out of 30 cases (70 %) with mean leak pressure of 570 mmHg and mean leak volume of 399 ml. Leakage occurred in 9 segments (30 %) with no reinforcement with a leak pressure of 329 mmHg and volume of 380 ml.

Conclusions

In vitro, Lembert’s suture reinforcement technique on stapled human stomach is associated with less leakage rate in comparison to through-and-through reinforcement and non-reinforced staple-line.

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Disclosures

Dr. Philip Schauer is consultant for Ethicon Endo-Surgery and receives grant funding from Ethicon and Covidien. Other authors have no conflicts of interest or financial ties to disclose which is related directly or indirectly to the subject of this manuscript.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Cleveland Clinic Institutional Review Board (IRB) approved the protocol under the number 15–047. Waiver for informed consent was approved by the IRB as there was no intervention or risk directly addressed to the patients. No identifying information is available in the article.

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Authors and Affiliations

  1. Cleveland Clinic, Bariatric and Metabolic Institute, 9500 Euclid Ave, M66-06, Cleveland, OH, 44118, USA

    Tomasz Rogula, Zhamak Khorgami, Ali Aminian & Philip Schauer

  2. Jagiellonian University Medical College, Krakow, Poland

    Martin Bazan & Cristina Mamolea

  3. University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Omar El-Shazly

  4. University of Buenos Aires, Buenos Aires, Argentina

    Pablo Acquafresca

Authors
  1. Tomasz Rogula
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  2. Zhamak Khorgami
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  3. Martin Bazan
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  4. Cristina Mamolea
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  5. Pablo Acquafresca
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  6. Omar El-Shazly
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  7. Ali Aminian
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  8. Philip Schauer
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Corresponding author

Correspondence to Tomasz Rogula.

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Rogula, T., Khorgami, Z., Bazan, M. et al. Comparison of Reinforcement Techniques Using Suture on Staple-Line in Sleeve Gastrectomy. OBES SURG 25, 2219–2224 (2015). https://doi.org/10.1007/s11695-015-1864-7

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  • DOI: https://doi.org/10.1007/s11695-015-1864-7

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