Reinforced Sleeve versus Non-Reinforced Sleeve Gastrectomy in Morbid Obese Patients: A comparative Study

Abstract

Background: Staple-line leaks after laparoscopic sleeve gastrectomy (LSG) remains a concerning complication in addition to other complications which may occur as bleeding and twisting. Buttressing of the staple line after sleeve gastrectomy is an acceptable reinforcement method but data recorded regarding leaks have been equivocal. Intraoperative measures are used as over-sewing of stapling line to prevent these events and several other methods are used to decrease and control these complications and decrease these burden. Although staple-line reinforcement in several studies is reported to decrease postoperative leakage and bleeding, other studies reported that reinforcement has no role. Authors also reported using buttressing materials. Our study is to compare between sleeve gastrectomy vs. reinforced sleeve gastrectomy with over-sewing of the staple line and omentopexy in morbid obese patients as regards overall complications as bleeding, Leakage and twist.Patients and methods: This prospective randomized Controlled trial involved 500 obese patients conducted during period from January 2018 to January 2019 with follow up till June 2019. The patients were divided into 2 groups, Group A (250 patients) underwent sleeve gastrectomy then reinforcement by suturing of sleeved stomach along the whole length of staple line with omentopexy and Group B (250 patients) underwent sleeve gastrectomy with no over sewing or omental patching.Results: There was a significant difference between the two study groups as regard operative time with longer mean operative time in omentopexy group. However, no statistically significant difference was found between the two study groups as regard post-operative leakage, hemorrhage and twisting although overall complications was less in reinforcement group and leaks detected in reinforcement group are mostly contained leaks but this was statistically insignificant. Conclusion:Minimal advantage is added to sleeve gastrectomy with reinforcement by over-sewing and omentopexy as regard post-operative leakage, hemorrhage and twisting although overall complications was less in reinforcement group and leaks detected in reinforcement group are mostly contained leaks but this was statistically insignificant so further studies is needed with larger sample size.