Seamguard Buttressing (SGB) and Oversewing/Suturing (OS/S) of the Staple Line in Sleeve Gastrectomy Appear to be Associated with Comparable Postoperative Outcomes. A Meta-Analysis of 11 Studies Comparing Two Effective Reinforcement Methods.

Abstract

Postoperative staple line hemorrhage and leakage are major causes of postoperative morbidity after laparoscopic sleeve gastrectomy (LSG). Many staple line reinforcement (SLR) techniques have been innovated in efforts to reduce such complications; these include oversewing/suturing (OS/S), omentopexy/gastropexy (OP/GP), gluing, and buttressing. Therefore, surgeons are often confused of which SLR they should use. Recent high-quality evidence shows that Seamguard buttressing (SGB) and OS/S are associated with better postoperative outcomes when each is compared to no SLR; having said that, it is unknown if one of these 2 methods is superior to the other. The aim of this study is to compare postoperative outcomes between LSG with SGB versus LSG with OS/S. Key points • No significant difference in postoperative bleeding, postoperative leakage, and readmission was observed between SGB and OS/S. • SGB was associated with decreased incidence of reoperations, and without significant heterogeneity which makes the decrease generalizable. However, when compared to OS/S, number need to treat (NNT) with SGB to prevent a case reoperation is 166. • OS/S was associated with shorter LOS, but this isn’t generalizable because of significant heterogeneity.