A Randomized Comparison Between Staple-Line Oversewing Versus No Reinforcement During Laparoscopic Vertical Sleeve Gastrectomy

Taha, Osama; Abdelaal, Mahmoud; Talaat, Mohamed; Abozeid, Mohamed

doi:10.1007/s11695-017-2835-y

Cited by 38 publications

(27 citation statements)

References 39 publications

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“…Taha et al suggested that staple-line reinforcement by hand-sewing may require additional operating time and that average surgical time is significantly shorter in patients who underwent LSG without oversewing of the staple line. 22 This aspect is also highlighted in the meta-analysis of Wang et al 14 The shorter surgical time detected in our series may be due to the fact that the introduction of the reinforced lines occurred when the learning curve of the surgical team had already been completed, adding enough experience to be able to decrease surgical time. Studies by Aggrwal et al and Sroka et al suggest that the diminished bleeding rate after oversewn LSG may be attributed to the learning curve effect and not only the efficacy and effectiveness of the method of reinforcing the stapling line.…”

Section: Discussionsupporting

confidence: 52%

Stapling technology with triple-row and enhanced staple configurations evaluated in a series of 124 consecutive laparoscopic vertical gastrectomies

et al. 2019

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Background: Laparoscopic sleeve gastrectomy (LSG) is a procedure frequently used to treat morbid obesity, due to its simplicity compared to other bariatric techniques. However, LSG can lead to serious complications, such as gastric leakage and bleeding from the staple line. To reduce these complications, seroserosal reinforcement of the mechanical suture line after gastrectomy is generally recommended. In recent decades, studies have focused on the safety of anastomosis with staples, especially compared to manual sewing techniques. Since studies on the improvement of stapling technology are limited, this study arises to compare the clinical results of staple line oversewing versus stapling technology with triple-row and enhanced staple configurations in laparoscopic sleeve gastrectomy.Methods: A retrospective review from a prospectively maintained database of 124 laparoscopic vertical gastrectomies performed at single centre between March 2010 and December 2016. Patients were divided into two groups, with comparable anthropometric parameters and inclusion criteria. Seroserosal reinforcement was used in the first group, and stapling technology with triple-row and enhanced staple configurations in the second. Rates of anastomotic leakage, bleeding, reoperation, and 30-day mortality were compared.Results: In Group 1 the average surgical time was 125 min, whereas in Group 2 it was 87 min. No differences were found between the two groups regarding leakage or bleeding of the staple line.Conclusions: The use of triple-row stapling devices during laparoscopic vertical gastrectomy enables surgical time to be reduced. Further high-quality studies to evaluate the efficacy and effectiveness of stapling technology with triple-row and enhanced staple configurations are needed.

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Section: Discussionsupporting

confidence: 52%

Stapling technology with triple-row and enhanced staple configurations evaluated in a series of 124 consecutive laparoscopic vertical gastrectomies

et al. 2019

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“…On this line, Gagner et al, in a powerful review on 88 papers, shows in the no reinforcement group an overall complication rate of 8.9%, and confirmed that buttressing LSG suture did not determine a statistical evidence on leaks [21]. Almost all device making for reinforcing determine generally a faster procedure compared with oversewing suture, that is suitable for experienced surgeons [22].…”

Section: Discussionmentioning

confidence: 99%

Omentopexy with Glubran®2 for reducing complications after laparoscopic sleeve gastrectomy: results of a randomized controlled study

et al. 2019

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BackgroundGastric fistulas, bleeding, and strictures are commonly reported after laparoscopic sleeve gastrectomy (LSG), that increase morbidity and hospital stay and may put the patient’s life at risk. We report our prospective evaluation of application of synthetic sealant, a modified cyanoacrylate (Glubran®2), on suture rime, associated with omentopexy, to identify results on LSG-related complications.MethodsPatients were enrolled for LSG by two Bariatric Centers, with high-level activity volume. Intraoperative recorded parameters were: operative time, estimated intraoperative bleeding, conversion rate. We prospectively evaluated the presence of early complications after LSG during the follow up period. Overall complications were analyzed. Perioperative data and weight loss were also evaluated. A control group was identified for the study.ResultsGroup A (treated with omentopexy with Glubran®2) included 96 cases. Control group included 90 consecutive patients. There were no differences among group in terms of age, sex and Body Mass Index (BMI). No patient was lost to follow-up for both groups. Overall complication rate was significantly reduced in Group A. Mean operative time and estimated bleeding did not differ from control group. We observed three postoperative leaks in Group B, while no case in Group A (not statistical significancy). We did not observe any mortality, neither reoperation. Weight loss of the cohort was similar among groups. In our series, no leaks occurred applying omentopexy with Glubran®2.ConclusionOur experience of omentopexy with a modified cyanoacrylate sealant may lead to a standardized and reproducible approach that can be safeguard for long LSG-suture rime.Trial registrationRetrospective registration on clinicaltrials.gov PRS, with TRN NCT03833232 (14/02/2019).

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“…These results were reported in multiple randomized controlled trials which demonstrated that the staple-line reinforcement in LSG had benefits over the postoperative staple-line hemorrhage and leakage. [17][18][19][20][21] Aggrwal et al and Sroka et al suggested that the diminished bleeding rate after oversewed LSG may be attributed to the learning curve effect and not only the efficacy of oversewing. 18,20 Miller et al and Kasalicky et al stated that the low hemorrhage rate with the buttressing material usage could be related to the more compression during tissue excision.…”

Section: Discussionmentioning

confidence: 99%

Staple line reinforcement during laparoscopic sleeve gastrectomy: pros and cons

Abdelmageed

Helmy

2019

Int Surg J

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Background: Nowadays, laparoscopic sleeve gastrectomy (LSG) is the most common performed bariatric procedure. Staple line reinforcement (SLR) advised for reducing gastric leaks and bleeding after LSG. The aim of this study is to evaluate the efficacy of SLR in reducing the postoperative complications compared to non-SLR during LSG.Method: Sixty morbid obese patients were scheduled for LSG in this prospective randomized study at Sohag University Hospital in the period between March 2016 to February 2018. Patients were divided randomly into two groups: Group I included 30 patients underwent LSG with over sewing of the staple line with running suture using VLoc™ V 3/0 suture. Group II underwent LSG without SLR (n=30).Results: No cases with leaks or stenosis were detected in our series. The operative time was significantly longer in the SLR group compared to the non-SLR group (125 (110-160) vs 100 (90-125) minutes respectively, p<0.01). Staple line bleeding was detected postoperatively only in one case in group II (3.3%) which was treated conservatively. The length of hospital stay was longer in the non-reinforcement group but not significantly different (p=0.25).Conclusions: Staple line reinforcement during LSG has no superiority on the outcome of this operation, used by surgeons as a personal preference and as a security shield rather than for its advantages.

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A Randomized Comparison Between Staple-Line Oversewing Versus No Reinforcement During Laparoscopic Vertical Sleeve Gastrectomy

Cited by 38 publications

References 39 publications

Stapling technology with triple-row and enhanced staple configurations evaluated in a series of 124 consecutive laparoscopic vertical gastrectomies

Stapling technology with triple-row and enhanced staple configurations evaluated in a series of 124 consecutive laparoscopic vertical gastrectomies

Omentopexy with Glubran®2 for reducing complications after laparoscopic sleeve gastrectomy: results of a randomized controlled study

Staple line reinforcement during laparoscopic sleeve gastrectomy: pros and cons

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