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How Does Oversewing/Suturing (OS/S) Compare to Other Staple Line Reinforcement Methods? A Systematic Review and Meta-Analysis

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Abstract

Various staple line reinforcement (SLR) techniques in sleeve gastrectomy, including oversewing/suturing (OS/S), gluing, and buttressing, have emerged to mitigate postoperative complications such as bleeding and leaks. A meta-analysis of randomized controlled trials has demonstrated OS/S as an efficacious strategy for preventing postoperative complications, encompassing leaks, bleeding, and reoperations. Given that OS/S is the sole SLR technique not incurring additional costs during surgery, our study aimed to compare postoperative outcomes associated with OS/S versus alternative SLR methods. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we reviewed the literature and conducted fifteen pairwise meta-analyses of comparative studies, each evaluating an outcome between OS/S and another SLR technique. Thirteen of these analyses showed no statistically significant differences, whereas two revealed notable distinctions.

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References

  1. Sher T, Noom M, Diab AR, et al. Efficacy of bariatric intervention as a bridge to cardiac transplant. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2023 Nov;19(11):1296–301.

  2. Ali M, El Chaar M, Ghiassi S, et al. American Society for Metabolic and Bariatric Surgery Clinical Issues Committee. American Society for Metabolic and Bariatric Surgery updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2017;13(10):1652–7.

    Article  Google Scholar 

  3. Iannelli A, Treacy P, Sebastianelli L, et al. Perioperative complications of sleeve gastrectomy: review of the literature. J Minimal Access Surg. 2019;15(1):1–7.

    Article  Google Scholar 

  4. Arslan E, Banli O, Sipahi M, et al. Effects and results of omentopexy during laparoscopic sleeve gastrectomy. Surg Laparosc Endosc Percutan Tech. 2018;28(3):174–7.

    Article  PubMed  Google Scholar 

  5. de Godoy EP, Coelho D. Gastric sleeve fixation strategy in laparoscopic vertical sleeve gastrectomy. Arq Bras Cir Dig ABCD Braz Arch Dig Surg. 2013;26(Suppl 1):79–82.

    Article  Google Scholar 

  6. Diab ARF, Oviedo RJ, Nazir S, et al. Foregut malignancy after metabolic surgery: a literature review. Obes Surg. 2022;33(2):623–34.

    Article  PubMed  Google Scholar 

  7. Diab ARF, Alfieri S, Doyle W, et al. Seamguard buttressing of the staple line during laparoscopic sleeve gastrectomy appears to decrease the incidence of postoperative bleeding, leaks, and reoperations. A systematic review and meta-analysis of non-randomized comparative studies. Obes Surg. 2023;33(7):2237–45.

    Article  PubMed  Google Scholar 

  8. Diab ARF, Sher T, Awshah S, et al. Oversewing/Suturing of the staple line during sleeve gastrectomy is an effective and affordable staple line reinforcement method: a meta-analysis of randomized controlled trials. Obes Surg. 2023;33(8):2533–45.

    Article  PubMed  Google Scholar 

  9. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5.

    Article  PubMed  Google Scholar 

  10. Mendes D, Alves C, Batel-Marques F. Number needed to treat (NNT) in clinical literature: an appraisal. BMC Med. 2017;15(1):112.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Cochrane Handbook for Systematic Reviews of Interventions.  Available from https://handbook-5-1.cochrane.org/. Accessed 28 Feb 2023.

  12. Furukawa TA, Guyatt GH, Griffith LE. Can we individualize the “number needed to treat”? An empirical study of summary effect measures in meta-analyses. Int J Epidemiol. 2002;31(1):72–6.

    Article  PubMed  Google Scholar 

  13. Armitage P, Colton T. Encyclopedia of Biostatistics, 8 Volume Set. Wiley; 2005. p. 6100.

    Book  Google Scholar 

  14. Barreto TW, Kemmeter PR, Paletta MP, et al. A comparison of a single center’s experience with three staple line reinforcement techniques in 1,502 laparoscopic sleeve gastrectomy patients. Obes Surg. 2015;25(3):418–22.

    Article  PubMed  Google Scholar 

  15. D’Ugo S, Gentileschi P, Benavoli D, et al. Comparative use of different techniques for leak and bleeding prevention during laparoscopic sleeve gastrectomy: a multicenter study. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2014;10(3):450–4.

    Article  Google Scholar 

  16. IFSO 2016 21st World Congress. Obes Surg. 2016;26(1):1–691.

  17. Guerrier JB, Mehaffey JH, Schirmer BD, et al. Reinforcement of the staple line during gastric sleeve: a comparison of buttressing or oversewing, versus no reinforcement- a single-institution study. Am Surg. 2018;84(5):690–4.

    Article  PubMed  Google Scholar 

  18. Albanopoulos K, Alevizos L, Flessas J, et al. Reinforcing the staple line during laparoscopic sleeve gastrectomy: prospective randomized clinical study comparing two different techniques. Preliminary results. Obes Surg. 2012;22(1):42–6.

    Article  PubMed  Google Scholar 

  19. Gentileschi P, Camperchioli I, D’Ugo S, et al. Staple-line reinforcement during laparoscopic sleeve gastrectomy using three different techniques: a randomized trial. Surg Endosc. 2012;26(9):2623–9.

    Article  PubMed  Google Scholar 

  20. Di Capua F, Cesana GC, Uccelli M, et al. Comparison of laparoscopic sleeve gastrectomy bleeding and leakage rates in four staple-line reinforcement methods: a prospective observational study. J Laparoendosc Adv Surg Tech. 2022;32(11):1176–80.

    Article  Google Scholar 

  21. Carandina S, Tabbara M, Bossi M, et al. Staple line reinforcement during laparoscopic sleeve gastrectomy: absorbable monofilament, barbed suture, fibrin glue, or nothing? Results of a prospective randomized study. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2016;20(2):361–6.

    Article  CAS  Google Scholar 

  22. Sroka G, Milevski D, Shteinberg D, et al. Minimizing hemorrhagic complications in laparoscopic sleeve gastrectomy–a randomized controlled trial. Obes Surg. 2015;25(9):1577–83.

    Article  PubMed  Google Scholar 

  23. VanderVennen M, Barreto T, Kemmeter K, et al. Cost comparison of three staple-line reinforcement techniques in vertical sleeve gastrectomy. Surg Obes Relat Dis. 2015;11(6):S203.

    Article  Google Scholar 

  24. Polega J, Barreto T, Kemmeter K, et al. Comparison of staple line reinforcement technique in vertical sleeve gastrectomy performed by a single surgeon. Surg Obes Relat Dis. 2015;11(6):S203–4.

    Article  Google Scholar 

  25. Fort JM, Gonzalez O, Caubet E, et al. Management of the staple line in laparoscopic sleeve gastrectomy: comparison of three different reinforcement techniques. Surg Endosc. 2021;35(7):3354–60.

    Article  PubMed  Google Scholar 

  26. Dapri G, Cadière GB, Himpens J. Reinforcing the staple line during laparoscopic sleeve gastrectomy: prospective randomized clinical study comparing three different techniques. Obes Surg. 2010;20(4):462–7.

    Article  PubMed  Google Scholar 

  27. Usta S, Karabulut K. Effect of fibrin glue or suture on leakage in patients undergoing laparoscopic sleeve gastrectomy. Niger J Clin Pract. 2018;21(9):1209–12.

    Article  CAS  PubMed  Google Scholar 

  28. Bülbüller N, Aslaner A, Öner OZ, et al. Comparison of four different methods in staple line reinforcement during laparascopic sleeve gastrectomy. Int J Clin Exp Med. 2013;6(10):985–90.

    PubMed  PubMed Central  Google Scholar 

  29. Shikora SA, Mahoney CB. Clinical benefit of gastric Staple Line Reinforcement (SLR) in gastrointestinal surgery: a meta-analysis. Obes Surg. 2015;25(7):1133–41.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Musella M, Milone M, Bellini M, et al. Laparoscopic sleeve gastrectomy. Do we need to oversew the staple line? Ann Ital Chir. 2011;82(4):273–7.

    PubMed  Google Scholar 

  31. Taha O, Abdelaal M, Talaat M, et al. A randomized comparison between staple-line oversewing versus no reinforcement during laparoscopic vertical sleeve gastrectomy. Obes Surg. 2018;28(1):218–25.

    Article  PubMed  Google Scholar 

  32. Dapri G, Vaz C, Cadière GB, et al. A prospective randomized study comparing two different techniques for laparoscopic sleeve gastrectomy. Obes Surg. 2007;17(11):1435–41.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA

    Abdul-Rahman F. Diab, Salvatore Docimo Jr, Joseph A. Sujka & Christopher G. DuCoin

  2. University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA

    Zachary Malaussena, Abrahim Ahmed & William West III

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  1. Abdul-Rahman F. Diab
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  2. Zachary Malaussena
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  3. Abrahim Ahmed
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  5. Salvatore Docimo Jr
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Correspondence to Abdul-Rahman F. Diab.

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Diab, AR.F., Malaussena, Z., Ahmed, A. et al. How Does Oversewing/Suturing (OS/S) Compare to Other Staple Line Reinforcement Methods? A Systematic Review and Meta-Analysis. OBES SURG 34, 985–996 (2024). https://doi.org/10.1007/s11695-024-07069-9

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