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Management of the staple line in laparoscopic sleeve gastrectomy: comparison of three different reinforcement techniques

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Abstract

Background

Nowadays, laparoscopic sleeve gastrectomy (LSG) is one of the most widely performed bariatric procedures. Different techniques have been described to reduce the rate of complications associated with the staple line, but no consensus has been reached.

The aim of this study was to determine the incidence of surgical complications after LSG with three different approaches to the staple line.

Patients and methods

A retrospective matched analysis was performed, comparing three groups of 100 patients each: partial oversewing of the staple line (PO group), complete oversewing of the staple line (CO group), and reinforcement with buttress material (BM group). Operative time, early surgical complications (superficial surgical site infection, leakage and hemorrhage), length of stay, weight evolution, and revisional surgery rates were analyzed.

Results

All three groups were comparable at baseline. All surgeries were performed laparoscopically. Operative time was significantly longer in the CO group (PO: 84.2 ± 22; CO: 104.7 ± 17; BM: 82.3 ± 22; PO vs CO, p = 0.021; BM vs CO, p = 0.011). There were no differences in length of stay, early surgical complications, and weight outcomes at 36 months between the groups. The need for a revisional surgery was significantly higher in the CO group compared to the PO group (PO: 3%; CO: 14%; BM: 9%; PO vs CO, p = 0.005).

Conclusion

The CO group required a longer operative time. There were no differences in early surgical complications between the groups. The CO group had a higher need for revisional surgery than the PO group.

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References

  1. Regan JP, Inabnet WB, Gagner M, Pomp A (2003) Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg 13:861–864. https://doi.org/10.1381/096089203322618669

    Article  CAS  PubMed  Google Scholar 

  2. Hess S, Hess W (1998) Biliopancreatic switch diversion with a duodenal. Obesity 8(3):267–282

    CAS  Google Scholar 

  3. Lagacé M, Marceau P, Marceau S, Hould F, Potvin M, Bourque R, Biron S (1995) Biliopancreatic diversion with a new type of gastrectomy: some previous conclusions revisited. Obes Surg 5:411–418. https://doi.org/10.1381/096089295765557511

    Article  PubMed  Google Scholar 

  4. Welbourn R, Hollyman M, Kinsman R, Dixon J, Liem R, Ottosson J, Ramos A, Våge V, Al-Sabah S, Brown W, Cohen R, Walton P, Himpens J (2019) Bariatric surgery worldwide: baseline demographic description and one-year outcomes from the fourth IFSO Global Registry Report 2018. Obes Surg 29:782–795. https://doi.org/10.1007/s11695-018-3593-1

    Article  PubMed  Google Scholar 

  5. Thorell A, MacCormick AD, Awad S, Reynolds N, Roulin D, Demartines N, Vignaud M, Alvarez A, Singh PM, Lobo DN (2016) Guidelines for Perioperative care in bariatric surgery: enhanced recovery after surgery (ERAS) society recommendations. World J Surg 40:2065–2083. https://doi.org/10.1007/s00268-016-3492-3

    Article  CAS  PubMed  Google Scholar 

  6. Saber AA, Scharf KR, Turk AZ, Elgamal MH, Martinez RLMC (2008) Early experience with intraluminal reinforcement of stapled gastrojejunostomy during laparoscopic Roux-en-Y gastric bypass. Obes Surg 18:525–529. https://doi.org/10.1007/s11695-008-9465-3

    Article  PubMed  Google Scholar 

  7. Rogula T, Khorgami Z, Bazan M, Mamolea C, Acquafresca P, El-Shazly O, Aminian A, Schauer P (2015) Comparison of reinforcement techniques using suture on staple-line in sleeve gastrectomy. Obes Surg 25:2219–2224. https://doi.org/10.1007/s11695-015-1864-7

    Article  PubMed  Google Scholar 

  8. Dapri G, Bernard Cadière G, Himpens J, Cadiere GB, Himpens J (2010) Reinforcing the staple line during laparoscopic sleeve gastrectomy: prospective randomized clinical study comparing three different techniques. Obes Surg 20:462–467. https://doi.org/10.1007/s11695-009-0047-9

    Article  PubMed  Google Scholar 

  9. 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 28:218–225. https://doi.org/10.1007/s11695-017-2835-y

    Article  PubMed  Google Scholar 

  10. Demeusy A, Sill A, Averbach A (2018) Current role of staple line reinforcement in 30-day outcomes of primary laparoscopic sleeve gastrectomy: an analysis of MBSAQIP data, 2015–2016 PUF. Surg Obes Relat Dis 14:1454–1461. https://doi.org/10.1016/j.soard.2018.06.024

    Article  PubMed  Google Scholar 

  11. Martines G, Digennaro R, de Fazio M, Capuano P (2017) Cyanoacrylate sealant compared to fibrin glue in staple line reinforcement during laparoscopic sleeve gastrectomy. Pilot prospective observational study. G Chir 38:50–52. https://doi.org/10.11138/gchir/2017.38.1.050

  12. Karakoyun R, Gündüz U, Bülbüller N, Çalış H, Habibi M, Öner O, Gülkesen H (2015) The effects of reinforcement methods on burst pressure in resected sleeve gastrectomy specimens. J Laparoendosc Adv Surg Tech A 25:64–68. https://doi.org/10.1089/lap.2014.0408

    Article  PubMed  Google Scholar 

  13. López-Monclova J, Soler ET, Ponz CB, Vilallonga R, Rodríguez-Gómez K, Baeza-Vitolas M (2013) Pilot study comparing the leak pressure of the sleeved stomach with and without reinforcement. Surg Endosc 27:4721–4730. https://doi.org/10.1007/s00464-013-3123-0

    Article  PubMed  Google Scholar 

  14. 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 22:1206–1213. https://doi.org/10.1007/s11695-012-0674-4

  15. Parikh M, Issa R, McCrillis A, Saunders JK, Ude-Welcome A, Gagner M (2013) Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg 257:231–237. https://doi.org/10.1097/SLA.0b013e31826cc714

    Article  PubMed  Google Scholar 

  16. Albanopoulos K, Tsamis D, Arapaki A, Kleidi E, Zografos G, Leandros E (2015) Staple line reinforcement with stitch in laparoscopic sleeve gastrectomies. is it useful or harmful? J Laparoendosc Adv Surg Tech A. https://doi.org/10.1089/lap.2014.0433

  17. Ruiz-Tovar J, Zubiaga L, Muñoz JL, Llavero C (2018) 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. Gagner M, Buchwald JN (2014) Comparison of laparoscopic sleeve gastrectomy leak rates in four staple-line reinforcement options: a systematic review. Surg Obes Relat Dis 10:713–723. https://doi.org/10.1016/j.soard.2014.01.016

    Article  PubMed  Google Scholar 

  19. Shikora SA, Mahoney CB (2015) Clinical benefit of gastric staple line reinforcement (SLR) in gastrointestinal surgery: a meta-analysis. Obes Surg 25:1133–1141. https://doi.org/10.1007/s11695-015-1703-x

    Article  PubMed  PubMed Central  Google Scholar 

  20. Stamou KM, Menenakos E, Dardamanis D, Arabatzi C, Alevizos L, Albanopoulos K, Leandros E, Zografos G (2011) Prospective comparative study of the efficacy of staple-line reinforcement in laparoscopic sleeve gastrectomy. Surg Endosc 25:3526–3530. https://doi.org/10.1007/s00464-011-1752-8

    Article  PubMed  Google Scholar 

  21. Vilallonga R, Hidalgo M, Ruiz Garcia, de Gordejuela A, Caubet E, Gonzalez O, Ciudin A, Rodríguez-Luna MR, Roriz-Silva R, Petrola C, Armengol M, Fort JM (2020) Operative and postoperative complications of laparoscopic sleeve gastrectomy in super and nonsuper obese patients: a center of excellence experience comparative study. J Laparoendosc Adv Surg Tech. https://doi.org/10.1089/lap.2019.0721

    Article  Google Scholar 

  22. Yavuz A, Buluş H (2017) The effect of reinforcement methods with knotted and knotless sutures: comparison of burst pressures. J Laparoendosc Adv Surg Tech 27:629–632. https://doi.org/10.1089/lap.2016.0074

    Article  Google Scholar 

  23. Sánchez-Santos R, Masdevall C, Baltasar A, Martínez-Blázquez C, Ruiz G, de Gordejuela A, Ponsi E, Sánchez-Pernaute A, Vesperinas G, Del Castillo D, Bombuy E, Durán-Escribano C, Ortega L, Ruiz de Adana JC, Baltar J, Maruri I, García-Blázquez E, Torres A (2009) Short- and Mid-term Outcomes of Sleeve Gastrectomy for Morbid Obesity: The Experience of the Spanish National Registry. Obes Surg 19:1203–1210. https://doi.org/10.1007/s11695-009-9892-9

  24. Sanchez Santos R, Corcelles R, Vilallonga Puy R, Delgado Rivilla S, Ferrer JV, Foncillas Corvinos J, Masdevall Noguera C, Socas Macias M, Gomes P, Balague Ponz C, de Tomas PJ, Ortiz Sebastian S, Sanchez Pernaute A, Puche Pla JJ, Sabench Pereferrer F, Abasolo Vega J, Suñol Sala X, Garcia Navarro A, Duran Escribano C, Cassinello Fernandez N, Perez N, Gracia Solanas JA, Garcia-Moreno Nisa F, Hernández Matias A, Valentí Azcarate V, Perez Folques JE, Navarro Garcia I, Dominguez-Adame Lanuza E, Martinez Cortijo S, González Fernández J (2017) Factores predictivos de pérdida ponderal tras la gastrectomía vertical. Estudio multicéntrico hispano-portugués Cir Esp 95:135–142. https://doi.org/10.1016/j.ciresp.2017.02.002

    Article  Google Scholar 

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Authors and Affiliations

  1. Endocrine, Metabolic and Bariatric Unit, Center of Excellence for the EAC-BC, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Passeig de la Vall d’Hebron 119-129, 08035, Barcelona, Spain

    José Manuel Fort, Oscar Gonzalez, Enric Caubet, Amador García Ruiz de Gordejuela, Marc Beisani & Ramon Vilallonga

  2. Department of Gastrointestinal Surgery, Hospital Clinic, Universitat de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain

    José Maria Balibrea

  3. General Surgery Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Passeig de la Vall d’Hebron 119-129, 08035, Barcelona, Spain

    Carlos Petrola & Manel Armengol

Authors
  1. José Manuel Fort
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  2. Oscar Gonzalez
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  3. Enric Caubet
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  4. José Maria Balibrea
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  5. Carlos Petrola
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  6. Amador García Ruiz de Gordejuela
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  7. Marc Beisani
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  8. Manel Armengol
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  9. Ramon Vilallonga
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Corresponding author

Correspondence to Ramon Vilallonga.

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Disclosures

Drs. Fort, Dr Gonzalez, Dr. Caubet, Dr. Balibrea, Dr. Petrola, Dr. Garcia, Dr. Beisani, Dr. Armengol, and Dr. Vilallonga have no conflicts of interest or financial ties to disclose. No funding was received for this publication.

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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.

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Fort, J.M., Gonzalez, O., Caubet, E. et al. Management of the staple line in laparoscopic sleeve gastrectomy: comparison of three different reinforcement techniques. Surg Endosc 35, 3354–3360 (2021). https://doi.org/10.1007/s00464-020-07773-4

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  • DOI: https://doi.org/10.1007/s00464-020-07773-4

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