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Staple Line Bleeding in Sleeve Gastrectomy—a Simple and Cost-Effective Solution

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Abstract

Background

Staple line bleeding (SLB) is a common intraoperative complication following resection in laparoscopic sleeve gastrectomy (SG). Opinion is divided on the best measure to deal with SLB which includes expensive reinforcement strategies, suturing the staple line or diathermy. Tranexemic acid is a relatively inexpensive drug known to reduce bleeding in trauma and surgery. The aim of this study was to evaluate whether intraoperative tranexemic acid reduces staple line bleeding.

Methods

In this prospective matched comparative study of SG, one cohort of patients was administered tranexemic acid (1 g) after induction and compared to a control group. The primary outcome compared the number of staple line bleeding points requiring intervention intra-operatively. Secondary outcomes included estimated blood loss and operating time. The anaesthetic and thromboprophylaxis protocols were uniform. Operative technique and stapling equipment were identical in all patients.

Results

Twenty-five patients were allocated to both the control and treatment arms. Patient characteristics in both groups were similar in age (median 34 vs 43 years), body mass index (median 54.7 vs 52 kg/m2), gender distribution (female:male = 20:5) and co-morbidities. The treatment group receiving tranexemic acid, required significantly less number of haemostatic stitches for staple line bleeding (19 vs 46, p < 0.05), incurred less intraoperative blood loss (p < 0.01) and had quicker operating times (median 66 vs 80 min, p < 0.05). There was no difference in morbidity or mortality in both groups.

Conclusion

Intraoperative prophylactic tranexemic acid use is a simple and economical option for effectively reducing staple line bleeds leading to significant decrease in operating times.

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Authors and Affiliations

  1. Department of Surgery, King’s College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK

    Saurav Chakravartty, Diwakar R. Sarma, Avril Chang & Ameet G. Patel

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  1. Saurav Chakravartty
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  2. Diwakar R. Sarma
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  3. Avril Chang
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  4. Ameet G. Patel
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Corresponding author

Correspondence to Ameet G. Patel.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Conflict of Interest

The authors declare that they have no competing interests.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Chakravartty, S., Sarma, D.R., Chang, A. et al. Staple Line Bleeding in Sleeve Gastrectomy—a Simple and Cost-Effective Solution. OBES SURG 26, 1422–1428 (2016). https://doi.org/10.1007/s11695-015-1986-y

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  • DOI: https://doi.org/10.1007/s11695-015-1986-y

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