Evaluating the effect of operative technique on leaks after laparoscopic sleeve gastrectomy: a case-control study

Varban, Oliver A.; Sheetz, Kyle H.; Cassidy, Ruth; Stricklen, Amanda; Carlin, Arthur M.; Dimick, Justin B.; Finks, Jonathan F.

doi:10.1016/j.soard.2016.11.027

Cited by 43 publications

(12 citation statements)

References 18 publications

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“…By contrast, there are many surgeons who chose to not reinforce the staple lines (NR) either for concern over the costs and/or the lack of proven benefits [15]. Many studies have been published to assess the impact of various reinforcement techniques on the prevention of early SLC [16][17][18][19]. However, outcomes were heterogeneous because of the retrospective design, limited sample sizes, and low postoperative complication rates.…”

Section: Introductionmentioning

confidence: 99%

Staple Line Reinforcement During Laparoscopic Sleeve Gastrectomy: Systematic Review and Network Meta-analysis of Randomized Controlled Trials

et al. 2022

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Purpose Staple line reinforcement (SLR) during laparoscopic sleeve gastrectomy (LSG) is controversial. The purpose of this study was to perform a comprehensive evaluation of the most commonly utilized techniques for SLR. Materials and Methods Network meta-analysis of randomized controlled trials (RCTs) to compare no reinforcement (NR), suture oversewing (SR), glue reinforcement (GR), bioabsorbable staple line reinforcement (Gore® Seamguard®) (GoR), and clips reinforcement (CR). Risk Ratio (RR), weighted mean difference (WMD), and 95% credible intervals (CrI) were used as pooled effect size measures. Results Overall, 3994 patients (17 RCTs) were included. Of those, 1641 (41.1%) underwent NR, 1507 (37.7%) SR, 689 (17.2%) GR, 107 (2.7%) GoR, and 50 (1.3%) CR. SR was associated with a significantly reduced risk of bleeding (RR=0.51; 95% CrI 0.31–0.88), staple line leak (RR=0.56; 95% CrI 0.32–0.99), and overall complications (RR=0.50; 95% CrI 0.30–0.88) compared to NR while no differences were found vs. GR, GoR, and CR. Operative time was significantly longer for SR (WMD=16.2; 95% CrI 10.8–21.7), GR (WMD=15.0; 95% CrI 7.7–22.4), and GoR (WMD=15.5; 95% CrI 5.6–25.4) compared to NR. Among treatments, there were no significant differences for surgical site infection (SSI), sleeve stenosis, reoperation, hospital length of stay, and 30-day mortality. Conclusions SR seems associated with a reduced risk of bleeding, leak, and overall complications compared to NR while no differences were found vs. GR, GoR, and CR. Data regarding GoR and CR are limited while further trials reporting outcomes for these techniques are warranted. Graphical abstract

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Section: Introductionmentioning

confidence: 99%

Staple Line Reinforcement During Laparoscopic Sleeve Gastrectomy: Systematic Review and Network Meta-analysis of Randomized Controlled Trials

et al. 2022

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“…Given that the majority of leaks occur several days after surgery, most probably, as a result of tissue ischemia or gastric wall hematomas, intraoperative testing might only be of benefit in a staple misfire. Over time, there have been improvements in surgical technique, which have reduced leaks with less risk of thermal injury, better staple height selection, choice of an adequate larger bougie size leading to less risk of narrowing, routine takedown of the short gastric vessels, and complete mobilization of the fundus [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Staple line reinforcement with nebulized cyanoacrylate glue in laparoscopic sleeve gastrectomy: A propensity score-matched study

et al. 2022

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Background A dreaded complication of laparoscopic sleeve gastrectomy (LSG) is suture leak. The study aimed to assess the efficacy of the nebulized comonomer Glubran 2® (N-butyl-cyanoacrylate + metacrylosysolfolane) applied to the LSG staple line. Methods A propensity-matched comparison analysis was conducted in 125 patients undergoing LSG between 2017 and 2019. Groups included those treated with Glubran® (group 1, n = 70) and those without Glubran® treatment (group 2, n = 55). Results There were differences in the mean body mass index (44.4 vs 43 kg/m2; P < 0.05) between the groups. There was a non-significant increase in the operative time for group 1 compared with group 2 (97 ± 8 vs 93.8 ± 10.7 min; P = 0.07), with a greater amount of estimated blood loss (94.5 mL vs 87.8; P < 0.01). There were more severe complications in group 2 over group 1 cases (8 vs 0%; P < 0.05), although postoperative bleeding did not differ between the two groups (1.4 vs 5.4%). There were no postoperative leaks in group 1 patients, but there were two leaks in group 2 cases with an increased length of hospital stay in patients with a leak. Conclusion Glubran® LSG support may reduce leak risk without increasing operating time.

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“…The bleeding rate of the . Because frequently oversewing the staple line is related with a decreased risk of leaks and bleeding, those surgeons were found to have greater expertise and a lower overall complication rate than those who did not habitually oversew the staple line (33)…”

Section: Discussionmentioning

confidence: 99%

Short-term outcomes of reinforcement of staple line during revisional laparoscopic sleeve gastrectomy.

salem¹,

Sakr²,

elgazzar

2022

Benha Medical Journal

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Background: Revisional sleeve gastrectomy has higher complications like bleeding and leakage so staple line reinforcement (SLR) is very important to decrease such dangerous events. Purpose: The purpose of this research is to investigate the effectiveness of utilizing barbed suture to strengthen the staple line during revisional laparoscopic sleeve gastrectomy performed following an unsuccessful laparoscopic adjustable gastric band procedure. Patients and methods: Patients were arranged into; group (A); 21 cases; underwent Laparoscopic Sleeve Gastrectomy (LSG) with stapler line strengthening by barbed suture and group (B); 21 cases; underwent LSG without strengthening. Patient follow-up period was 6 months. Results: There was no mortality. No significant differences between both groups as regard to preoperative data and hospital stay. Group (A) was performed in longer time; 109 ± 2.3 vs. 78 ± 1.4 in group (B). Postoperative leak was reported only in group (B); 2 patients (4.8%) and frequency of bleeding was more in group (B); 4 patients (9.6%) P-value for leak and bleeding was 0.037 & 0.048. Conclusions: Revisional Sleeve gastrectomy by laparoscopy is still safer and minimally invasive procedure. Adding barbed suture reinforcement of the staple line is a weapon to decrease incidence of postoperative leak and bleeding to a great extent.

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Evaluating the effect of operative technique on leaks after laparoscopic sleeve gastrectomy: a case-control study

Cited by 43 publications

References 18 publications

Staple Line Reinforcement During Laparoscopic Sleeve Gastrectomy: Systematic Review and Network Meta-analysis of Randomized Controlled Trials

Staple Line Reinforcement During Laparoscopic Sleeve Gastrectomy: Systematic Review and Network Meta-analysis of Randomized Controlled Trials

Staple line reinforcement with nebulized cyanoacrylate glue in laparoscopic sleeve gastrectomy: A propensity score-matched study

Short-term outcomes of reinforcement of staple line during revisional laparoscopic sleeve gastrectomy.

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