Skip to main content
SpringerLink
Log in

Integrated Bioabsorbable Tissue Reinforcement in Laparoscopic Sleeve Gastrectomy

  • Short Communication
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Division of the stomach in laparoscopic sleeve gastrectomy may be performed using bare stapler cartridges or cartridges fitted with tissue reinforcement strips, with or without oversewing. Many tissue reinforcement strips are after-market add-on products that must be fitted onto a stapler during surgery. A retrospective review was conducted of 85 consecutive patients undergoing laparoscopic sleeve gastrectomy using a novel integrated bioabsorbable polymer buttress pre-mounted on a single-use loading unit stapler. Mean preoperative body mass index (BMI) was 41.7 ± 5.2 kg/m2. Morbidity and short-term outcomes were documented. Mean follow-up was 8.1 ± 3.6 months (range, 1.0–16.2 months). There were no mortalities or staple line leaks noted in this series with short-term follow up. The major complication rate (grade III and above) was 7.1% and included: reoperation for staple line bleeding (2.4%, n = 2), gastric sleeve stenosis requiring balloon dilation (2.4%, n = 2), choledocholithiasis 2 weeks after surgery (1.2%, n = 1), and reoperation without abnormality for suspected perioperative obstruction (1.2%, n = 1). Mean percent excess BMI loss at 3 (44.6 ± 11.3), 6 (57.9 ± 17.2), and 12 months (72.4 ± 27.5) was comparable to other published series. The use of an integrated absorbable synthetic polymer for stapled tissue reinforcement in laparoscopic sleeve gastrectomy appears to be feasible and safe, and yields results consistent with other published techniques.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Regan JP, Inabnet WB, Gagner M, et al. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg. 2003;13:861–4.

    Article  PubMed  CAS  Google Scholar 

  2. Almogy G, Crookes PF, Anthone GJ. Longitudinal gastrectomy as a treatment for the high-risk super-obese patient. Obes Surg. 2004;14:492–7.

    Article  PubMed  Google Scholar 

  3. Sanchez-Santos R, Masdevall C, Baltasar A, et al. Short- and mid-term outcomes of sleeve gastrectomy for morbid obesity: the experience of the Spanish National Registry. Obes Surg. 2009;19:1203–10.

    Article  PubMed  Google Scholar 

  4. Lee CM, Cirangle PT, Jossart GH. Vertical gastrectomy for morbid obesity in 216 patients: report of two-year results. Surg Endosc. 2007;21:1810–6.

    Article  PubMed  Google Scholar 

  5. Chen B, Kiriakopolous A, Tsakayannis D, et al. 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 

  6. Giannopoulos GA, Tzanakis NE, Rallis GE, et al. Staple line reinforcement in laparoscopic bariatric surgery: does it actually make a difference? A systematic review and meta-analysis. Surg Endosc. 2010;24:2782–8.

    Article  PubMed  Google Scholar 

  7. Lalor PF, Tucker ON, Szomstein S, et al. Complications after aparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2008;4:33–8.

    Article  PubMed  Google Scholar 

  8. Consten EC, Gagner M, Pomp A, et al. Decreased bleeding after laparoscopic sleeve gastrectomy with or without duodenal switch for morbid obesity using a stapled buttress absorbable polymer membrane. Obes Surg. 2004;14:1360–6.

    Article  PubMed  Google Scholar 

  9. Chae FH, McIntyre RC, Stiegmann GV. Anastomotic staple-line reinforcement enhances the safety of laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc. 2001;15:S113.

    Google Scholar 

  10. Pugliese R, Maggioni D, Sansonna F, et al. Laparoscopic distal pancreatectomy: a retrospective review of 14 cases. Surg Laparosc Endosc Percutan Tech. 2008;18:254–9.

    Article  PubMed  Google Scholar 

  11. Murray KD, Ho CH, Hsia JYJ, et al. The influence of pulmonary staple line reinforcement on air leaks. Chest. 2002;122:2146–9.

    Article  PubMed  Google Scholar 

  12. Consten ECJ, Dakin GF, Robertus JL, et al. Perioperative outcome of laparoscopic left lateral liver resection is improved by using a bioabsorbable staple line reinforcement material in a porcine model. Surg Endosc. 2008;22:1188–93.

    Article  PubMed  Google Scholar 

  13. Franklin ME, Berghoff KE, Arellano PP, et al. Safety and efficacy of the use of bioabsorbable seamguard in colorectal surgery at the Texas endosurgery institute. Surg Laparosc Endosc Percutan Tech. 2005;15:9–13.

    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. Burgos AM, Braghetto I, Csendes A, et al. Gastric leak after laparoscopic-sleeve gastrectomy for obesity. Obes Surg. 2009;19:1672–7.

    Article  PubMed  Google Scholar 

  16. 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  PubMed  CAS  Google Scholar 

  17. Fris RJ. Preoperative low energy diet diminishes liver size. Obes Surg. 2004;14:1165–70.

    Article  PubMed  Google Scholar 

  18. Alley JB, Fenton SJ, Peterson RM. The “tip-stitch”: a time-saving technique for specimen extraction in sleeve gastrectomy. Obes Surg. 2009;19:926–7.

    Article  PubMed  Google Scholar 

  19. Dindo D, Demartines N, Clavien PA. Classification of surgical complications. A new proposal with evaluation in a cohort of 6,336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  Google Scholar 

  20. Nguyen NT, Longoria M, Welbourne S, et al. Glycolide copolymer staple-line reinforcement reduces staple site bleeding during laparoscopic gastric bypass. A prospective randomized trial. Arch Surg. 2005;140:773–8.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  22. Nocca D, Krawczykowsky D, Bomans B, et al. A prospective multicenter study of 163 sleeve gastrectomies: results at 1 and 2 years. Obes Surg. 2008;18:560–5.

    Article  PubMed  CAS  Google Scholar 

  23. Jacobs M, Bisland W, Gomez E, et al. Laparoscopic sleeve gastrectomy: a retrospective review of 1- and 2- year results. Surg Endosc. 2009;24(4):781–5.

    Article  PubMed  Google Scholar 

  24. Frezza EE, la Torre EJ Jaramillo-de, Enriquez CC, et al. Laparoscopic sleeve gastrectomy after gastric banding removal: a feasibility study. Surg Innov. 2009;16:68–72.

    Article  PubMed  Google Scholar 

  25. Iannelli A, Schneck AS, Ragot E, et al. Laparoscopic sleeve gastrectomy as revisional procedure for failed gastric banding and vertical banded gastroplasty. Obes Surg. 2009;19:1216–20.

    Article  PubMed  Google Scholar 

  26. Acholonu E, McBean E, Court I, et al. Safety and short-term outcomes of laparoscopic sleeve gastrectomy as a revisional approach for failed laparoscopic adjustable gastric banding in the treatment of morbid obesity. Obes Surg. 2009;19:1612–6.

    Article  PubMed  Google Scholar 

  27. Himpens J, Schepper M, Dapri G. Laparoscopic conversion of adjustable gastric banding to sleeve gastrectomy: a feasibility study. Surg Laparosc Endosc Percutan Tech. 2010;20(3):162–5.

    Article  PubMed  Google Scholar 

  28. Foletto M, Prevedello L, Bernante P, et al. Sleeve gastrectomy as revisional procedure for failed gastric banding or gastroplasty. Surg Obes Relat Dis. 2010;6:146–51.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

Drs. Alley, Fenton, Harnisch, and Peterson and Mr. Angeletti have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Surgery, San Antonio Military Medical Center, 59th SSS/SGO2G, Lackland AFB/Fort Sam Houston, San Antonio, TX, USA

    Joshua B. Alley, Stephen J. Fenton, Michael C. Harnisch, Michael N. Angeletti & Richard M. Peterson

  2. Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    Joshua B. Alley, Stephen J. Fenton & Richard M. Peterson

  3. Department of Defense, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Joshua B. Alley, Stephen J. Fenton & Richard M. Peterson

Authors
  1. Joshua B. Alley
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephen J. Fenton
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael C. Harnisch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael N. Angeletti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Richard M. Peterson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joshua B. Alley.

Additional information

The opinions expressed on this document are solely those of the authors and do not represent an endorsement by or the views of the United States Air Force, the Department of Defense, or the United States Government.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Alley, J.B., Fenton, S.J., Harnisch, M.C. et al. Integrated Bioabsorbable Tissue Reinforcement in Laparoscopic Sleeve Gastrectomy. OBES SURG 21, 1311–1315 (2011). https://doi.org/10.1007/s11695-010-0313-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-010-0313-x

Keywords

Search

Navigation