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Reinforcing the Staple Line During Laparoscopic Sleeve Gastrectomy: Does It Have Advantages? A Meta-analysis

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Abstract

Background

This study aims to identify whether reinforcing the staple line during laparoscopic sleeve gastrectomy (LSG) has advantages.

Methods

We searched MEDLINE (PubMed; till August 2011), EMBASE (till August 2011), and the Cochrane Central Register of Controlled Trials (Central) in the Cochrane Library (till August 2011) using common keywords related to sleeve gastrectomy and reinforcement. The keywords were as follows: “sleeve gastrectomy” and “reinforcement,” or “reinforcing,” or “reinforce,” or “leak,” or “leakage,” or “staple,” or “stapling,” or “oversew,” or “oversewing,” or “oversewed.” The language of publication was limited to English only.

Results

Of the 358 articles meeting our initial criteria, eight full texts (two randomized control trial [RCT] and six cohort studies), involving 1,345 participants (828 patient cases and 517 controls) were included in the final analysis. Comparing the reinforcement of the staple line to no reinforcement of the staple line, the odds ratio (OR) for overall complications was 0.521 (95 % confidence intervals [CI], 0.349–0.777). In addition, the OR for staple line leak was 0.425 (95 % CI, 0.226–0.799) and for staple line hemorrhage was 0.559 (95 % CI, 0.247–1.266).

Conclusion

The current study showed that reinforcing the staple line during LSG has the following advantages: decreased incidence of postoperative leak and overall complications. More prospective studies with better evidence are needed.

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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 high-risk super-obese patient. Obes Surg. 2004;14:492–7.

    Article  PubMed  Google Scholar 

  3. Cottam D, Qureshi FG, Mattar G, et al. Laparoscopic sleeve gastrectomy as an initial weight loss procedure for high-risk patients with morbid obesity. Surg Endosc. 2006;20:859–63.

    Article  PubMed  CAS  Google Scholar 

  4. Fuks D, Verhaeghe P, Brehant O. Results of laparoscopic sleeve gastrectomy: a prospective study in 135 patients with morbid obesity. Surgery. 2009;145:106–13.

    Article  PubMed  Google Scholar 

  5. Arias E, Martinez PR, Li VKM, et al. Mid-term follow-up after sleeve gastrectomy as a final approach for morbid obesity. Obes Surg. 2009;19:544–8.

    Article  PubMed  Google Scholar 

  6. 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 

  7. Wells GA, Shea B, O’Connel D, et al. The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm

  8. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17:1–12.

    Article  PubMed  CAS  Google Scholar 

  9. 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 buttressed absorbable polymer membrane. Obes Surg. 2004;14:1360–6.

    Article  PubMed  Google Scholar 

  10. Silecchia G, Rizzello M, Casella G, et al. Two-stage laparoscopic biliopancreatic diversion with duodenal switch as treatment of high-risk super-obese patients: analysis of complications. Surg Endosc. 2009;23:1032–7.

    Article  PubMed  CAS  Google Scholar 

  11. Sánchez-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 

  12. Ser JH, Lee WJ, Lee YH, et al. Experience in laparoscopic sleeve gastrectomy for morbidly obese Taiwanese: staple-line reinforcement is important for preventing leakage. Surg Endosc. 2010;24:2253–9.

    Article  PubMed  Google Scholar 

  13. 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 

  14. Daskalakis M, Berdan Y, Theodoridou S, et al. Impact of surgeon experience and buttress material on postoperative complications after laparoscopic sleeve gastrectomy. Surg Endosc. 2011;25:88–97.

    Article  PubMed  Google Scholar 

  15. Stamou KM, Menenakos E, Dardamanis D, et al. Prospective comparative study of the efficacy of staple-line reinforcement in laparoscopic sleeve gastrectomy. Surg Endosc. 2011;25:3526–30.

    Article  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  17. Wassner JD, Yohai E, Heimlich H. Complications associated with the use of gastrointestinal stapling devices. Surgery. 1997;82:393–9.

    Google Scholar 

  18. Chen B, Kiriakopoulos 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 

  19. 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 

  20. Gagner M, Deitel M, Kalberer BA, 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 

  21. Han SM, Kim WW, Oh JH. Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obes Surg. 2005;15:1469–75.

    Article  Google Scholar 

  22. Frezza EE, Reddy S, Gee LL, et al. Complication after sleeve gastrectomy for morbid obesity. Obes Surg. 2008;19:684–7.

    Article  PubMed  Google Scholar 

  23. Lee MG, Provost DA, Jones DB. Use of fibrin sealant in laparoscopic gastric bypass for morbid obesity. Obes Surg. 2004;14:1321–6.

    Article  PubMed  Google Scholar 

  24. 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 

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

    Article  PubMed  Google Scholar 

  26. Baker RS, Foote J, Kemmeter P, et al. A comparison of staple leaks with cartridge selection, oversewing and buttressing. Obes Surg. 2003;13:487–583.

    Article  Google Scholar 

  27. Consten EC, Gagner M. Staple-line reinforcement techniques with different buttressing materials used for laparoscopic gastrointestinal surgery: a new strategy to diminish perioperative complications. Surg Technol Int. 2004;13:59–63.

    PubMed  Google Scholar 

  28. Rubin M, Yehoshua RT, Stein M. Laparoscopic sleeve gastrectomy with minimal morbidity. Early results in 120 morbidly obese patients. Obes Surg. 2008;18:1567–70.

    Article  PubMed  Google Scholar 

  29. Shikora SA, Kim JJ, Tarnoff ME. Reinforcing gastric staple lines with bovine pericardial strips may decrease the likelihood of gastric leak after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003;13:37–44.

    Article  PubMed  Google Scholar 

  30. Farrell TM, Haggerty SP, Overby DW, et al. Clinical application of laparoscopic bariatric surgery: an evidence-based review. Surg Endosc. 2009;23:930–49.

    Article  PubMed  Google Scholar 

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Conflicts of Interest

All authors have no commercial interest.

Author information

Authors and Affiliations

  1. Department of Surgery, The Armed Forces Ildong Hospital, Pocheon, Republic of Korea

    Yoon Young Choi

  2. Department of Dermatology, The Armed Forces Ildong Hospital, Pocheon, Republic of Korea

    Jungmin Bae

  3. Department of Surgery, Soonchunhyang University College of Medicine, Seoul, 140-743, Republic of Korea

    Kyung Yul Hur, Dongho Choi & Yong Jin Kim

Authors
  1. Yoon Young Choi
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  2. Jungmin Bae
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  3. Kyung Yul Hur
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Correspondence to Kyung Yul Hur.

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Choi, Y.Y., Bae, J., Hur, K.Y. et al. Reinforcing the Staple Line During Laparoscopic Sleeve Gastrectomy: Does It Have Advantages? A Meta-analysis. OBES SURG 22, 1206–1213 (2012). https://doi.org/10.1007/s11695-012-0674-4

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  • DOI: https://doi.org/10.1007/s11695-012-0674-4

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