Laparoscopic sleeve gastrectomy (LSG) can cause gastric twist/torsion, gastroesophageal reflux disease (GERD), and prolonged postoperative nausea and vomiting (PONV). In addition, bleeding and leaks are the most feared complications in the early postoperative period. Various staple line reinforcement (SLR) techniques have been innovated to reduce the incidence of bleeding and leaks; as oversewing (OS), omentopexy/gastropexy (OP/GP), buttressing, and gluing. OP/GP isn’t only an SLR method that is used for prevention of bleeding and leaks, but also a staple line fixation method that few surgeons use to prevent gastric twist/torsion, and motility related complications as GERD and prolonged PONV. The goal of this study is to compare postoperative outcomes between LSG with OP/GP and LSG without OP/GP or any other SLR method. Key points • OP/GP decreases, leaks, bleeding, readmissions, prolonged PONV, gastric twist/torsion, and GERD. This was consistent in all studies (no heterogeneity). • OP/GP appears to decrease length of stay and prolonged antacids use at 12 months postoperatively, but this isn’t on solid ground due to significant heterogeneity observed among studies. • The only disadvantage of OP/GP is the increase in operative time.

Leaks and bleeding are major acute postoperative complications following laparoscopic sleeve gastrectomy (LSG). Various staple line reinforcement (SLR) methods have been invented such as oversewing, omentopexy/gastropexy, gluing, and buttressing. However, many surgeons don't use any type of reinforcement. On the other hand, surgeons who use a reinforcement method are often confused of what kind of reinforcement they should use. No robust and high-quality data supports the use of one reinforcement over the other, or even supports the use of reinforcement over no reinforcement. Therefore, SLR is a controversial topic that is worth our focus. The aim of this study is to compare the outcomes of LSG with versus without Seamguard buttressing of the staple line during LSG. Key PointsSeamguard buttressing decreases the incidence of postoperative bleeding.Seamguard buttressing decreases the incidence of postoperative leaks.Seamguard buttressing decreases the incidence of re-operations.No heterogeneity among studies was observed, a conclusion reached after calculating prediction intervals and I 2 .

Leaks and bleeding are major acute postoperative complications following laparoscopic sleeve gastrectomy (LSG). Various staple line reinforcement (SLR) methods have been invented such as oversewing, omentopexy/gastropexy, gluing, and buttressing. However, many surgeons don’t use any type of reinforcement. On the other hand, surgeons who use a reinforcement method are often confused of what kind of reinforcement they should use. No robust and high-quality data supports the use of one reinforcement over the other, or even supports the use of reinforcement over no reinforcement. Therefore, SLR is a controversial topic that is worth our focus. The aim of this study is to compare the outcomes of LSG with versus without Seamguard buttressing of the staple line during LSG.

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