Abstract
Background
Gastric leak and hemorrhage are the most important challenges after laparoscopic sleeve gastrectomy (LSG). In order to reduce these complications, the staple line can be reinforced by absorbable sutures or by the use of glycolide trimethylene carbonate copolymer onto the linear stapler (Gore Seamguard®; W.L. Gore & Associates, Inc, Flagstaff, AZ). To our knowledge, there are no randomized studies showing the utility of staple line reinforcement during LSG. The purpose of this study was to randomly compare three techniques in LSG: no staple line reinforcement (group 1), buttressing of the staple line with Gore Seamguard® (group 2), and staple line suturing (group 3).
Methods
Between January 2008 and February 2009, 75 patients were prospectively and randomly enrolled in the three different techniques of handling the staple line during LSG. The patient groups were similar (NS).
Results
Mean operative time to perform the stomach sectioning was 15.9 ± 5.9 min (group 1), 20.8 ± 8.1 min (group 2), and 30.8 ± 10.1 min (group 3) (p < 0.001). Mean total operative time was 47.4 ± 10.7 min (group 1), 48.9 ± 18.4 min (group 2), and 59.9 ± 19.6 min (group 3) (p = 0.02). Mean blood loss during stomach sectioning was 19.5 ± 21.3 mL (group 1), 3.6 ± 4.7 mL (group 2), and 16.7 ± 23.5 mL (group 3) (p < 0.001). Mean total blood loss was 48.9 ± 67.1 mL (group 1), 32.5 ± 46.5 mL (group 2), and 61.9 ± 69.4 mL (group 3) (p = 0.03). Mean number of stapler cartridges used was 5.6 ± 0.7 (group 1), 5.7 ± 0.7 (group 2), and 5.8 ± 0.6 (group 3) (NS). Postoperative leak affected one patient (group 1), two patients (group 2), and one patient (group 3) (NS). Mean hospital stay was 3.6 ± 1.4 days (group 1), 3.9 ± 1.5 days (group 2), and 2.8 ± 0.8 days (group 3) (p = 0.01).
Conclusions
In LSG, buttressing the staple line with Gore Seamguard® statistically reduces blood loss during stomach sectioning as well as overall blood loss. No staple line reinforcement statistically decreases the time to perform stomach sectioning and the total operative time. No significant difference is evidenced in terms of postoperative leak between the three techniques of LSG.
Similar content being viewed by others
References
Deitel M, Crosby RD, Gagner M. The First International Consensus Summit for Sleeve Gastrectomy (SG), New York City, October 25–27, 2007. Obes Surg. 2008;18:487–96.
Gagner M, Deitel M, Kalberer TL, et al. The second International Consensus Summit for Sleeve Gastrectomy, March 19–21, 2009. Surg Obes Relat Dis. 2009;5:476–85.
Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis. 2009;5:469–75.
Serra C, Baltasar A, Andreo L, et al. Treatment of gastric leaks with coated self-expanding stents after sleeve gastrectomy. Obes Surg. 2007;17:866–72.
Crookes P. Management of severe reflux after sleeve gastrectomy. Second International Consensus Summit for Sleeve Gastrectomy, Miami Beach (FL, USA), March 19–21, 2009 (abstract)
Dapri G, Cadière GB, Himpens J. Laparoscopic seromyotomy for long stenosis after sleeve gastrectomy with or without duodenal switch. Obes Surg. 2009;19:495–9.
Langer FB, Bohdjalian A, Felberbauer FX, et al. Does gastric dilatation limit the success of sleeve gastrectomy as a sole operation for morbid obesity? Obes Surg. 2006;16:166–71.
Gagner M, Gumbs AA, Milone L, et al. Laparoscopic sleeve gastrectomy for the super-super-obese (body mass index >60 kg/m2). Surg Today. 2008;38:399–403.
Dapri G, Vaz C, Cadière GB, et al. A prospective randomized study comparing two different techniques for laparoscopic sleeve gastrectomy. Obes Surg. 2007;17:1435–41.
Dapri G, Cadière GB, Himpens J. Laparoscopic conversion of adjustable gastric banding and vertical gastroplasty to duodenal switch. Surg Obes Relat Dis. 2009;5:678–83.
Baltasar A, Bou R, Bengochea M, et al. Use of a Roux limb to correct esophagogastric junction fistula after sleeve gastrcetomy. Obes Surg. 2007;17:1408–10.
Eisendrath P, Cremer M, Himpens J, et al. Endotherapy including temporary stenting of fistula of the upper gastrointetsinal tract after laparoscopic bariatric surgery. Endoscopy. 2007;39:625–30.
Consten ECJ, Gagner M, Pomp A, et al. Decreased bleeding after laparoscopic sleeve gastrectomy with or without duodenal switch for morbid obesity using a stapled buttresses absorbable polymer membrane. Obes Surg. 2004;14:1360–6.
Miller KA, Pump A. Use of bioabsorbable staple reinforcement material in gastric bypass: a prospective randomized clinical trial. Surg Obes Relat Dis. 2007;3:417–22.
Shikora SA, Kim JJ, Tarnoff ME. Comparison of permanent and nonpermanent staple line buttressing materials for linear gastric staple lines during laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2008;4:729–34.
Angrisani L, Lorenzo M, Borrelli V, et al. The use of bovine pericardial strips on linear stapler to reduce extraluminal bleeding during laparoscopic gastric bypass: prospective randomized clinical trial. Obes Surg. 2004;14:1198–202.
Pinheiro JS, Correa JL, Cohen RV, et al. Staple line reinforcement with new biomaterial increased burst strength pressure: an animal study. Surg Obes Relat Dis. 2006;2:397–9.
Downey DM, Harre JG, Dolan JP. Increased burst pressure in gastrointestinal staple-lines using reinforcement with a bioprosthetic material. Obes Surg. 2005;15:1379–83.
Kasalicky M, Michalsky D, Housova J, et al. Laparoscopic sleeve gastrectomy without an over-sewing of the staple line. Obes Surg. 2008;18:1257–62.
Chen B, Kiriakopoulos A, Tsakayannis D. Reinforcement does not necessarily reduce the rate of staple line leaks after sleeve gastrectomy. A review of the literature and clinical experiences. Obes Surg. 2009;19:166–72.
Yehoshua RT, Eidelman LA, Stein M, et al. Laparoscopic sleeve gastrectomy-volume and pressure assessment. Obes Surg. 2008;18:1083–8.
Elariny H, Gonzales H, Wang B. Tissue thickness of human stomach measured on excised gastric specimens from obese patients. Surg Technol Int. 2005;14:119–24.
Casella G, Soricelli E, Rizzello M, et al. Nonsurgical treatment of staple line leaks after laparoscopic sleeve gastrectomy. Obes Surg. 2009;19:821–6.
Baker RS, Foote J, Kemmeter P, et al. The science of stapling and leaks. Obes Surg. 2004;14:1290–8.
Nelson LG, Gonzales R, Haines K, et al. Amelioration of gastroesophageal reflux symptoms following Roux-en-Y gastric bypass for clinically significant obesity. Am Surg. 2005;71:950–3.
Merrouche M, Sabate’ JM, Jouet P, et al. Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients before and after bariatric surgery. Obes Surg. 2007;17:894–900.
Disclosures
The authors have no commercial associations that might be a conflict of interest in relation to this article.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dapri, G., Cadière, G.B. & Himpens, J. Reinforcing the Staple Line During Laparoscopic Sleeve Gastrectomy: Prospective Randomized Clinical Study Comparing Three Different Techniques. OBES SURG 20, 462–467 (2010). https://doi.org/10.1007/s11695-009-0047-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-009-0047-9