Skip to main content
Log in

Reinforcing the Staple Line During Laparoscopic Sleeve Gastrectomy: Prospective Randomized Clinical Study Comparing Three Different Techniques

  • Clinical Research
  • Published:
Obesity Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. 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.

    Article  PubMed  Google Scholar 

  2. 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.

    Article  PubMed  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. 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)

  6. 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.

    Article  PubMed  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  10. 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.

    Article  PubMed  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  CAS  PubMed  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. 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.

    Article  PubMed  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. 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.

    Article  PubMed  Google Scholar 

  17. 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.

    Article  PubMed  Google Scholar 

  18. 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.

    Article  PubMed  Google Scholar 

  19. 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.

    Article  PubMed  Google Scholar 

  20. 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.

    Article  PubMed  Google Scholar 

  21. Yehoshua RT, Eidelman LA, Stein M, et al. Laparoscopic sleeve gastrectomy-volume and pressure assessment. Obes Surg. 2008;18:1083–8.

    Article  PubMed  Google Scholar 

  22. 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.

    PubMed  Google Scholar 

  23. Casella G, Soricelli E, Rizzello M, et al. Nonsurgical treatment of staple line leaks after laparoscopic sleeve gastrectomy. Obes Surg. 2009;19:821–6.

    Article  CAS  PubMed  Google Scholar 

  24. Baker RS, Foote J, Kemmeter P, et al. The science of stapling and leaks. Obes Surg. 2004;14:1290–8.

    Article  PubMed  Google Scholar 

  25. 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.

    PubMed  Google Scholar 

  26. 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.

    Article  PubMed  Google Scholar 

Download references

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Giovanni Dapri.

Rights and permissions

Reprints 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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-009-0047-9

Keywords

Navigation