Postoperative Bleeding Risk after Sleeve Gastrectomy. A Two Techniques of Stapled Line Reinforcement Comparative Study in 4996 Patients

Banescu, Bogdana; Bălescu, Irina; Copăescu, Cătălin

doi:10.21614/chirurgia.114.6.693

Cited by 7 publications

(3 citation statements)

References 29 publications

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“…In the literature there are very few studies that analyze post-operative bleeding after LSG, only 2 studies consider the increasing of the mean arterial pressure (MAP) by 30% and none the reducing the pneumoperitoneal pressure of CO2; Banescu et al has shown that the intraoperative risen of the blood pressure (BP) with 30% helps identifying and controlling the bleeding sources thus reducing the incidence of postoperative bleeding in LSG [ 30 ]. Ying et al concluded in their study that postoperative haemorrhage requiring transfusion in bariatric surgery patients who, at the time of closure, do not appear to have any evidence of bleeding is a rare but challenging complication that patients with postoperative bleeding were relatively assumptions regarding their baseline blood pressure during a critical window of surgery when the operation is complete and the abdomen is inspected for potential bleeding from the operating table [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Bariatric surgery: to bleed or not to bleed? This is the question

et al. 2022

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Background Bariatric surgery procedures are the most successful and durable treatment for morbid obesity. Hemorrhage represents a life-threatening complication, occurring in 1.3–1.7% of bariatric surgeries. Materials and methods We examined patients undergoing Bariatric Surgery from July 2017 to June 2020 (Group A) and those operated from July 2020 to June 2022 (Group B) in our Department. Starting from July 2020 we have implemented intraoperative measures to prevent postoperative bleeding, increasing mean arterial pressure (MAP) by 30% compared to preoperative and reducing the pneumoperitoneal pressure of CO2 to 8 mmHg in the last 15 min of the operation. Results The study gathered 200 patients divided into the two described groups. The mean age of Group A is 44 ± 8.49 and 43.73 ± 9.28. The mean preoperative BMI is 45.6 kg/m2 ± 6.71 for Group A and 48.9 ± 7.15 kg/m2 for Group B. Group A recorded a mean MAP of 83.06 ± 18.58 mmHg and group B a value of 111.88 ± 12.46 mmHg (p value < 0.05 and z-score is 4.15226 and the value of U is 13,900). We observed 9 cases of bleeding in group A, most of them being treated with medical therapy and transfusions; only 1 hemodynamically unstable patient underwent re-laparoscopy. We reported only 2 cases of bleeding in group B, one of which required blood transfusions. Conclusion From our study we can conclude that increasing mean arterial pressure (MAP) by 30% compared to preoperative and reducing the pneumoperitoneum pressure of CO2 to 8 mmHg in the last 15 min of the operation led to a decrease in bleeding cases in group B and, most importantly, all the bleedings were easily controllable with medical therapy and/or transfusions. These measures allowed us to reduce postoperative bleeding.

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Section: Discussionmentioning

confidence: 99%

Bariatric surgery: to bleed or not to bleed? This is the question

et al. 2022

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“…Bleeding can occur intra-abdominally or intraluminally, and the source of bleeding is typically the staple line, trocar site, dissected omental tissue, or damaged spleen or liver. Post-LSG bleeding is also associated with complications such as pneumonia, cardiac disease, surgical site infection, acute kidney injury, pulmonary embolism, reoperation, and mortality [6,7,8,9]. This knowledge…”

Section: Introductionmentioning

confidence: 90%

Efficacy of Omentopexy on Complications of Laparoscopic Sleeve Gastrectomy

Kara,

Ozel,

Yardimci

2024

OBES SURG

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Background Laparoscopic sleeve gastrectomy (LSG) is a commonly performed type of bariatric surgery. Early complications of LSG include bleeding, leakage, pulmonary embolism, and surgical site infections. Most surgeons try to implement preventive methods, such as omentopexy. Staple line-imbrication, which has a difficult learning curve, often prevents complications. This study aimed to evaluate the effect of omentopexy on patients with imbricated LSG. Material and Methods The study applied a retrospective data analysis design to patients who underwent LSG between 2020 and 2023. All patients’ staple lines were imbricated, and patients were then divided into two groups: omentopexy group and control group. Patients’ demographic features, such as age, gender, height, weight, body mass index(BMI), bleeding, leakage, and reoperations, were recorded and examined retrospectively. Results A total of 1356 patients were included in the study (540 in omentopexy, 816 in control), of which the mean age was 37.9 ± 10.5 years, 82.3% were women, and mean BMI was 40.9 ± 5.8 kg/m2. The mean bleeding rate was 1.0% (1.3–0.7%), the mean leakage rate was 0.2% (0.2–0.2%, respectively), and the mean reoperation rate was 0.6% (0.7% and 0.5%, respectively). No statistically significant differences were observed. Conclusion Omentopexy is a technique that is widely used to prevent staple line complications. According to our study, omentopexy applied to an imbricated stapler line increased the operation time but did not affect bleeding or leakage ratios. This is the first study to evaluate the effect of omentopexy on imbricated staple lines. The findings of the study indicate that omentopexy has no additional benefit on early complications when using staple-line imbrication. Graphical Abstract

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“…We regularly (not only after balloon insertion) suture all staple lines during LSG with 3-0 V-loc running suture. Primarily, we believe in its hemostatic value [5]. In balloon cases, where the size of the staples can be easily mismatched, it seems to be even more important [6].…”

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confidence: 98%