Evaluating the Effect of Staple Line Reinforcement on Reducing the Complications of Laparoscopic Sleeve Gastrectomy: A Randomized Clinical Trial
Laparoscopic sleeve gastrectomy (LSG) is the most common bariatric surgery technique. In this technique, bleeding and staple line the leakage is considered as the most important complications. The current study aimed at evaluating the effect of reinforced the taple line on the level of bleeding and leakage after the surgery. Overall, 199 patients meeting the eligible criteria with morbid obesity (BMI>40 kg/m2) were enrolled in the study after signing the written informed consent. Patients were randomly allocated to intervention group (with reinforced staple line) and control group (Standard treatment) using simple randomization technique. Out of 199 cases, 120 (60%) were female, and 80 (40%) male; their mean BMI was 44.79± kg/m2, ranging from 40 to 58 kg/m2. Staple site bleeding was observed; therefore, no significant relationship was observed between the groups regarding bleeding decrease. Staple line leakage was observed in 2 cases of the control (without reinforcement) group and none of the cases in the intervention (with reinforcement) group. According to the results of the current study, no statistically significant relationship was observed between the groups regarding the level of leakage (P=0.249). Also, there was no significant relationship between age, gender, and BMI of cases, and the level of bleeding and leakage from the staple site. The average duration of surgery was 52.03 and 69.64 minutes for the control and intervention groups, respectively, which indicated prolonged surgery in the intervention group (P<0.001). The current study results indicated no significant relationship between the groups regarding the level of bleeding and leakage from the staple site.
Rosenthal RJ, Panel ISGE. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of> 12,000 cases. Surgery for Obesity and Related Diseases. 2012;8(1):8-19.
Updated position statement on sleeve gastrectomy as a bariatric procedure. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2012;8(3):e21-6.
Bohdjalian A, Langer FB, Shakeri-Leidenmühler S, Gfrerer L, Ludvik B, Zacherl J, et al. Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obesity surgery. 2010;20(5):535-40.
Baltasar A, Serra C, Pérez N, Bou R, Bengochea M, Ferri L. Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obesity surgery. 2005;15(8):1124-8.
Fischer L, Hildebrandt C, Bruckner T, Kenngott H, Linke GR, Gehrig T, et al. Excessive weight loss after sleeve gastrectomy: a systematic review. Obesity surgery. 2012;22(5):721-31.
Foletto M, Prevedello L, Bernante P, Luca B, Vettor R, Francini-Pesenti F, et al. Sleeve gastrectomy as revisional procedure for failed gastric banding or gastroplasty. Surgery for Obesity and Related Diseases. 2010;6(2):146-51.
Lacy A, Obarzabal A, Pando E, Adelsdorfer C, Delitala A, Corcelles R, et al. Revisional surgery after sleeve gastrectomy. Surgical Laparoscopy Endoscopy & Percutaneous Techniques. 2010;20(5):351-6.
Givon-Madhala O, Spector R, Wasserberg N, Beglaibter N, Lustigman H, Stein M, et al. Technical aspects of laparoscopic sleeve gastrectomy in 25 morbidly obese patients. Obesity surgery. 2007;17(6):722-7.
Nguyen N, Longoria M, Chalifoux S, Wilson S. Bioabsorbable staple line reinforcement for laparoscopic gastrointestinal surgery. Surgical technology international. 2004;14:107-11.
Franklin Jr ME, Ramila GP, Treviño JM, González JJ, Russek K, Glass JL, et al. The use of bioabsorbable staple line reinforcement for circular stapler (BSG “Seamguard”) in colorectal surgery: initial experience. Surgical Laparoscopy Endoscopy & Percutaneous Techniques. 2006;16(6):411-5.
Consten EC, Gagner M, Pomp A, Inabnet WB. Decreased bleeding after laparoscopic sleeve gastrectomy with or without duodenal switch for morbid obesity using a stapled buttressed absorbable polymer membrane. Obesity surgery. 2004;14(10):1360-6.
Albanopoulos K, Alevizos L, Flessas J, Menenakos E, Stamou KM, Papailiou J, et al. Reinforcing the staple line during laparoscopic sleeve gastrectomy: prospective randomized clinical study comparing two different techniques. Preliminary results. Obesity surgery. 2012;22(1):42-6.
Rogula T, Khorgami Z, Bazan M, Mamolea C, Acquafresca P, El-Shazly O, et al. Comparison of reinforcement techniques using suture on staple-line in sleeve gastrectomy. Obesity surgery. 2015;25(11):2219-24.
Knapps J, Ghanem M, Clements J, Merchant AM. A systematic review of staple-line reinforcement in laparoscopic sleeve gastrectomy. JSLS. 2013;17(3):390-9.
Baker RS, Foote J, Kemmeter P, Brady R, Vroegop T, Serveld M. The science of stapling and leaks. Obesity surgery. 2004;14(10):1290-8.
Burgos AM, Braghetto I, Csendes A, Maluenda F, Korn O, Yarmuch J, et al. Gastric leak after laparoscopic-sleeve gastrectomy for obesity. Obesity surgery. 2009;19(12):1672.
Márquez MF, Ayza MF, Lozano RB, Morales MdMR, Díez JMG, Poujoulet RB. Gastric leak after laparoscopic sleeve gastrectomy. Obesity surgery. 2010;20(9):1306-11.
Deitel M, Gagner M, Erickson AL, Crosby RD. Third International Summit: current status of sleeve gastrectomy. Surgery for Obesity and Related Diseases. 2011;7(6):749-59.
Ren CJ, Patterson E, Gagner M. Early results of laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients. Obesity surgery. 2000;10(6):514-23.
Silecchia G, Boru C, Pecchia A, Rizzello M, Casella G, Leonetti F, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obesity Surgery. 2006;16(9):1138-44.
Gagner M, Buchwald JN. Comparison of laparoscopic sleeve gastrectomy leak rates in four staple-line reinforcement options: a systematic review. Surgery for Obesity and Related Diseases. 2014;10(4):713-23.
Godoy EPd, Coelho D. Gastric sleeve fixation strategy in laparoscopic vertical sleeve gastrectomy. ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo). 2013;26:79-82.
Chen B, Kiriakopoulos A, Tsakayannis D, Wachtel MS, Linos D, Frezza EE. Reinforcement does not necessarily reduce the rate of staple line leaks after sleeve gastrectomy. A review of the literature and clinical experiences. Obesity surgery. 2009;19(2):166-72.
Frezza EE. Laparoscopic vertical sleeve gastrectomy for morbid obesity. The future procedure of choice? Surgery today. 2007;37(4):275-81.
Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surgery for Obesity and Related Diseases. 2009;5(4):469-75.
Serra C, Baltasar A, Andreo L, Pérez N, Bou R, Bengochea M, et al. Treatment of gastric leaks with coated self-expanding stents after sleeve gastrectomy. Obesity surgery. 2007;17(7):866-72.
Hawasli A, Bush A, Hare B, Meguid A, Thatimatla N, Szpunar S. Laparoscopic management of severe reflux after sleeve gastrectomy, in selected patients, without conversion to roux-en-Y gastric bypass. Journal of Laparoendoscopic & Advanced Surgical Techniques. 2015;25(8):631-5.
Moszkowicz D, Arienzo R, Khettab I, Rahmi G, Zinzindohoué F, Berger A, et al. Sleeve gastrectomy severe complications: is it always a reasonable surgical option? Obesity surgery. 2013;23(5):676-86.
Benedix F, Benedix DD, Knoll C, Weiner R, Bruns C, Manger T, et al. Are there risk factors that increase the rate of staple line leakage in patients undergoing primary sleeve gastrectomy for morbid obesity? Obesity surgery. 2014;24(10):1610-6.
Consten EC, Dakin GF, Gagner M. Intraluminal migration of bovine pericardial strips used to reinforce the gastric staple-line in laparoscopic bariatric surgery. Obesity surgery. 2004;14(4):549-54.
Lalor PF, Tucker ON, Szomstein S, Rosenthal RJ. Complications after laparoscopic sleeve gastrectomy. Surgery for Obesity and Related Diseases. 2008;4(1):33-8.
Dapri G, Cadière GB, Himpens J. Reinforcing the staple line during laparoscopic sleeve gastrectomy: prospective randomized clinical study comparing three different techniques. Obesity surgery. 2010;20(4):462-7.
Angrisani L, Lorenzo M, Borrelli V, Ciannella M, Bassi UA, Scarano P. The use of bovine pericardial strips on linear stapler to reduce extraluminal bleeding during laparoscopic gastric bypass: prospective randomized clinical trial. Obesity surgery. 2004;14(9):1198-202.
Puig CA, Waked TM, Baron TH, Song LMWK, Gutierrez J, Sarr MG. The role of endoscopic stents in the management of chronic anastomotic and staple line leaks and chronic strictures after bariatric surgery. Surgery for Obesity and Related Diseases. 2014;10(4):613-7.
Rached AA, Basile M, El Masri H. Gastric leaks post sleeve gastrectomy: review of its prevention and management. World Journal of Gastroenterology: WJG. 2014;20(38):13904.
Rayburn GL, Riffle RG, Walburn FJ, Williams BG. Device and method for reinforcing surgical staples. Google Patents; 1997.
Shah SS, Todkar JS, Shah PS. Buttressing the staple line: a randomized comparison between staple-line reinforcement versus no reinforcement during sleeve gastrectomy. Obes Surg 2014;24:2014-20.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.