Role of staple line fixation during laparoscopic sleeve gastrectomy

Elbalshy, Mohammed A.; Fayed, Asem; Abdelshahid, Moharm A.; Alkhateep, Yahia

doi:10.18203/2349-2902.isj20175887

Cited by 10 publications

(4 citation statements)

References 27 publications

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“…In the literature, in a small number of studies evaluating the effects of SLR-O during LSG, similar to our findings, leakage, bleeding, and twist rates were found to be low (Table 4). [21][22][23][24] Afaneh et al's 25 study found that there was no significant difference between the omentopexy and standard LSG groups in the number of postoperative clinic visits, office telephone encounters, total postoperative readmissions, or postoperative readmissions associated with gastrointestinal symptoms such as nausea and vomiting.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Staple Line Reinforcement With Omentopexy During Laparoscopic Sleeve Gastrectomy on Postoperative Complications: Experience of a Single Center

Lale

Aygen

Kırkıl

et al. 2020

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: The aim of this study was to evaluate the protective effects of staple line reinforcement with omentopexy during laparoscopic sleeve gastrectomy on postoperative complications.Materials and Methods: A total of 3942 laparoscopic sleeve gastrectomy cases were included in the study. All the patients were divided into 3 groups: No reinforcement (NoSLR), staple line reinforcement with fibrin glue (SLR-FG), and staple line reinforcement with omentopexy (SLR-O). Demographic data and perioperative characteristics of the groups were analyzed retrospectively. Among these, age, sex, preoperative comorbidities, American Society of Anesthesiologists scores, body mass index, duration of operation, reoperation, complications, and Clavien-Dindo classification scores were recorded.Results: Age, sex, body mass index, comorbid diseases, American Society of Anesthesiologists, and Clavien-Dindo Classification scores were similar in all the groups. The overall complication rate was 3.0%. The overall minor and major complication rates were 1.7% and 1.3%, respectively. The mortality rate was 0.1% (4 patients). The most common postoperative complications were bleeding (0.9%) and leakage (0.5%). The incidence of leakage, bleeding, and twisted gastric sleeve rates were similar when compared between SLR-FG and NoSLR. In the SLR-O patients, the incidence of leakage, hemorrhage, and twist were significantly lower and the operation time was significantly longer when compared with the other groups. Conclusions:The SLR-O technique, especially when performed by experienced surgeons, is a promising method for the prevention of postoperative leakage, bleeding, and twist complications with an acceptable increase in the duration of operation. Considering the limited effects of the SLR-FG technique, it was predicted that it would lose its popularity over time.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Staple Line Reinforcement With Omentopexy During Laparoscopic Sleeve Gastrectomy on Postoperative Complications: Experience of a Single Center

Lale

Aygen

Kırkıl

et al. 2020

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…22,29,36 Various theories about how OP/GP prevents sleeve torsion are briefly reviewed here. According to Elbalshy's 2018 study, 37 the cause of spiral or twisted gastric sleeve might be the progressive rotation of the staple line in an anterior to posterior plane. The reason behind gastric sleeve twist/torsion is likely that the gastrosplenic and gastrocolic ligaments that fix the posterior wall of the stomach are cut, and the new stomach becomes mobile.…”

Section: Gastric Twist/torsionmentioning

confidence: 99%

Omentopexy/Gastropexy (OP/GP) Following Sleeve Gastrectomy Might be an Effective 2-in-1 Method (Reinforcement and Fixation): A Meta-Analysis of 14 Studies and a Call for Randomized Controlled Trials

Diab,

Alfieri,

DeBlieux

et al. 2023

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: Laparoscopic sleeve gastrectomy can lead to dangerous complications as leaks and hemorrhage. In addition, it can lead to gastric twist/torsion, prolonged postoperative nausea and vomiting (PONV), and de novo gastroesophageal reflux disease (GERD). We aimed to study the efficacy of omentopexy/gastropexy (OP/GP) in the prevention of these postoperative complications. Materials and Methods: PubMed and Google Scholar were queried in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data was analyzed using the Review Manager (RevMen) 5.4.1 software. Mantel-Haenszel statistical method and random effects analysis model were used in all meta-analyses. The odds ratio was used for dichotomous data. Subgroup analysis was done according to bougie size. Subgroup analysis according to the distance between the starting point of gastric transection and pylorus was not possible (limitation). Odds ratio and control event rate across studies were used to calculate the number needed to treat (NNT) with OP/GP for an additional beneficial outcome (prevention of adverse outcome) to occur. Results: The initial search identified 442 records; 371 were found irrelevant after screening and were excluded. The remaining 71 reports were retrieved and assessed for eligibility. An additional 57 reports were excluded following an in-depth assessment. The remaining 14 studies were included in this meta-analysis; 8 were nonrandomized studies (NRSs) while 6 were randomized controlled trials. Most studies originated from a single country (limitation). A statistically significant decrease in favor of OP/GP was observed for all outcomes (bleeding, leaks, gastric twist/torsion, prolonged PONV 1 month postoperatively, and postoperative de novo GERD). Data was consistent across studies (low I 2), and subgroup analysis according to bougie size revealed no subgroup differences. However, this study had 3 limitations that does not allow for strong conclusions. Conclusions: Although the current literature lacks strong scientific evidence, this study suggests that omentopexy/gastropexy (OP/GP) may offer protection against bleeding and leaks as a staple line reinforcement method, as well as against gastric twist/torsion, prolonged postoperative nausea and vomiting (PONV), and de novo gastroesophageal reflux disease (GERD) as a staple line fixation method. Therefore, it is worthwhile to proceed with large-scale, multicenter, randomized controlled trials to reevaluate our findings. Furthermore, conducting a comparison between OP/GP and other staple line reinforcement techniques would be beneficial.

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“…The overall mortality rate was 0.3%. The most common mortality was due to pulmonary embolism, cardiopulmonary failure and gastric fistula (5).…”

Section: Introductionmentioning

confidence: 99%

Effect of Spleen Size on Complications of Laparoscopic Sleeve Gastrectomy

arıcı¹

2023

Laparosc Endosc Surg Sci

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Introduction:In bariatric surgery, examining the spleen dimensions via USG in a routine manner prior to surgery, could help the physician to predict probable complications on bariatric surgery as enlarged spleen size restricts the surgeon's working area and leaks often occur in the upper part of the stomach adjacent to the spleen. The aim of this research was to elucidate the benefits of spleen USG in pre-operative period to determine the risk of complications in advance. Materials and Methods:A total of 316 patients who had undergone sleeve gastrectomy have been retrospectively analyzed. The spleen dimensions of the patients were obtained from the routine USG reports and CT scans. In this research we took the spleen size as 12 cm from the previous radiological studies in the literature and stated the ones above this reference point. Results:The number of staples and duration of surgery were higher in individuals with abnormal spleen size compared to individuals with normal spleen dimensions. Presence of CAD -arrhythmia and asthma -COPD were effective in the development of complications (p<0.05) according to logistic regression analysis. Considering the factors affecting the development of complications, CAD-Arrhythmia caused a 5-fold increase, and asthma-COPD 4.9-fold increased the development of complications. Conclusion:In patients scheduled for bariatric surgery, examining spleen dimensions via USG imaging in a routine manner prior to surgery, could help the physician to predict probable complications on bariatric surgery due to spleen size.

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Role of staple line fixation during laparoscopic sleeve gastrectomy

Cited by 10 publications

References 27 publications

Efficacy of Staple Line Reinforcement With Omentopexy During Laparoscopic Sleeve Gastrectomy on Postoperative Complications: Experience of a Single Center

Efficacy of Staple Line Reinforcement With Omentopexy During Laparoscopic Sleeve Gastrectomy on Postoperative Complications: Experience of a Single Center

Omentopexy/Gastropexy (OP/GP) Following Sleeve Gastrectomy Might be an Effective 2-in-1 Method (Reinforcement and Fixation): A Meta-Analysis of 14 Studies and a Call for Randomized Controlled Trials

Effect of Spleen Size on Complications of Laparoscopic Sleeve Gastrectomy

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