Early Experience with Intraluminal Reinforcement of Stapled Gastrojejunostomy During Laparoscopic Roux-En-Y Gastric Bypass

Abstract

Intraluminal reinforcement of gastrojejunal anastomosis during laparoscopic gastric bypass is safe and feasible. The use of intraluminal bioabsorbable glycolide copolymer staple-line reinforcement significantly reduces the incidence of gastrojejunal bleeding.

Use of staple-line reinforcement in laparoscopic gastric bypass surgery: a meta-analysis

“…Six studies [2,12,13,16,27,28] encompassing 416 patients who underwent LGBP were retrieved from the electronic databases. Two studies [2,12,16] were excluded due to nonrandomization and the comparison of other techniques of SLR. The remaining three randomized, controlled trails [13,27,28] on 180 patients qualified for this review according to inclusion criteria.…”

“…Several intraoperative techniques have been implemented to prevent the anastomosis leak as well as to control staple-line bleeding during LGBP. These interventions include the use of linear staplers with shorter staple height, oversewing of staple-line, use of omental wrap, and measures designed to reinforce staple-line, such as fibrin glue, Peristrips Ò , Seamguard Ò , bovine pericardium (permanent and nonpermanent), and various other staple-line reinforcement materials [2,[11][12][13][14][15][16].…”

Staple line reinforcement in laparoscopic bariatric surgery: does it actually make a difference? A systematic review and meta-analysis

“…Buttressing materials were initially used in thoracic surgery to reduce air leaks [12]. Absorbable (SeamGuard, PSD Veritas) and non-absorbable (PeriStrips Dry) materials have also been used widely in colorectal and bariatric surgery [17]. The concept seems attractive, as staples are anchored, not into friable tissue, but into the buttressing material, which is denser and sturdier.…”

“…Also, buttressing materials are reported to be effective in decreasing staple line bleeding (intra-and extraluminal) and thus operative time [18]. In fact, several studies [17,18] have found that buttressing materials have a better impact in reducing bleeding than leak rate. Possibly, the higher burst pressure offered by buttressed stapling is valuable in special cases, such as obstruction.…”

Reducing gastrointestinal anastomotic leak rates: review of challenges and solutions

“…[81][82][83] Consequently, advocates of bioabsorbable staple-line reinforcement should likely site potential reduction in staple line anastomotic stricture (which has been demonstrated) as their impetus for use rather than decreasing leak rate. 84,85 Suture reinforcement A number of authors have advocated placing reinforcing sutures about an anastomosis. There sutures are typically placed around the anastomosis, but intraluminal reinforcement with sutures has also been described.…”