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Are There Risk Factors That Increase the Rate of Staple Line Leakage in Patients Undergoing Primary Sleeve Gastrectomy for Morbid Obesity?

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Abstract

Background

Laparoscopic sleeve gastrectomy (LSG) is currently being performed with increasing frequency worldwide. It offers an excellent weight loss and resolution of comorbidities in the short term with a very low incidence of complications. However, the ever present risk of a staple line leak is still a major concern.

Methods

Since 2005, data from obese patients that undergo bariatric procedures in Germany are prospectively registered in an online database and analyzed at the Institute of Quality Assurance in Surgical Medicine. For the current analysis, all patients that had undergone primary sleeve gastrectomy for morbid obesity within a 7-year period were considered.

Results

Using the GBSR, data from 5.400 LSGs were considered for analysis. Staple line leak rate decreased during the study period from 6.5 to 1.4 %. Male gender, higher BMI, concomitant sleep apnea, conversion to laparotomy, longer operation time, use of both buttresses and oversewing, and the occurrence of intraoperative complications were associated with a significantly higher leakage rate. On multivariate analysis, operation time and year of procedure only had a significant impact on staple line leak rate.

Conclusions

The results of the current study demonstrated that there are factors that increase the risk of a leakage which would enable surgeons to define risk groups, to more carefully select patients, and to offer a closer follow-up during the postoperative course with early recognition and adequate treatment. All future efforts should be focused on a further reduction of serious complications to make the LSG a widely accepted and safer procedure.

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Acknowledgments

The German Nationwide Survey on Bariatric Surgery is supported by the Ministry of Research and Education Germany (BMBF) grant number 01GI1124. The responsible investigator is C. Stroh. We thank all hospitals that actively participated in the study.

Conflict of Interest

All authors (Benedix F, Benedix DD, Knoll C, Weiner R, Bruns C, Manger T, Stroh C) declare that there is no conflict of interest.

The following firms support the GBSR without any relation to their products: Johnson & Johnson MEDICAL GmbH, Ethicon Endo-Surgery Deutschland, Norderstedt and Covidien Deutschland GmbH, Neustadt/Donau.

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Authors and Affiliations

  1. Department of Surgery, University Hospital Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany

    Frank Benedix, Diana D. Benedix & Christiane Bruns

  2. SRH Municipal Hospital Gera, Straße des Friedens 122, 07548, Gera, Germany

    Thomas Manger & Christine Stroh

  3. StatConsult Magdeburg, Halberstädter Strasse 40a, 39112, Magdeburg, Germany

    Christian Knoll

  4. Hospital Sachsenhausen, Schulstrasse 31, 60594, Frankfurt/Main, Germany

    Rudolf Weiner

Authors
  1. Frank Benedix
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  2. Diana D. Benedix
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  3. Christian Knoll
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  4. Rudolf Weiner
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  5. Christiane Bruns
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  6. Thomas Manger
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  7. Christine Stroh
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Consortia

Obesity Surgery Working Group

Competence Network Obesity

Corresponding author

Correspondence to Frank Benedix.

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Benedix, F., Benedix, D.D., Knoll, C. et al. Are There Risk Factors That Increase the Rate of Staple Line Leakage in Patients Undergoing Primary Sleeve Gastrectomy for Morbid Obesity?. OBES SURG 24, 1610–1616 (2014). https://doi.org/10.1007/s11695-014-1257-3

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  • DOI: https://doi.org/10.1007/s11695-014-1257-3

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