Staple Line Bleeding in Sleeve Gastrectomy—a Simple and Cost-Effective Solution

Chakravartty, Saurav; Sarma, Diwakar Ryali; Chang, Avril; Patel, Ameet G.

doi:10.1007/s11695-015-1986-y

Cited by 41 publications

(52 citation statements)

References 38 publications

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“…Choosing the appropriate length of staples is believed to play some role in the prevention of this complication [30]. A study by Chakravartty et al reports that tranexamic acid could be an additional, simple, and cost-effective method for prophylaxis of staple line bleeding [31]. Possible methods for managing the bleeding during an operation include compression, ligation, clipping, and suturing [32].…”

Section: Discussionmentioning

confidence: 99%

What Makes Bariatric Operations Difficult–Results of a National Survey

et al. 2019

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Background and objective: The most commonly performed bariatric procedures include laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (LRYGB), and one anastomosis gastric bypass-mini gastric bypass (OAGB-MGB). A study comparing the degree of difficulty among those procedures could serve as a guide for decision making in bariatric surgery and further improve training programs for general surgery trainees. The aim of this study was to compare the subjective level of technical difficulty of LSG, LRYGB, and OAGB–MGB as perceived by surgeons and surgical residents. Materials and Methods: An anonymous internet-based survey was designed to evaluate the subjective opinions of surgeons and surgical residents in training in Poland. It covered baseline characteristics of the participants, difficulty of LSG, OAGB-MGB, LRYGB and particular stages of each operation assessed on a 1–5 scale. Results: Overall, 70 surgeons and residents participated in our survey. The mean difficulty degree of LSG was 2.34 ± 0.89. The reinforcing staple line with sutures was considered most difficult stage of this operation (3.17 ± 1.19). The LRYGB operation had an average difficulty level of 3.87 ± 1.04. Creation of the gastrojejunostomy was considered the most difficult stage of LRYGB with a mean difficulty level (3.68 ± 1.16). Responders to our survey assessed the mean degree of difficulty of OAGB-MGB as 2.34 ± 0.97. According to participating surgeons, creating the gastrojejunostomy is the most difficult phase of this operation (3.68 ± 1.16). Conclusion: The LSG is perceived by surgeons as a relatively easy operation. The LRYGB was considered to be the most technically challenging procedure in our survey. Operative stages, which require intra-abdominal suturing with laparoscopic instruments, seem to be the most difficult phases of each operation.

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Section: Discussionmentioning

confidence: 99%

What Makes Bariatric Operations Difficult–Results of a National Survey

et al. 2019

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“…Presumably clinicians are reluctant to use this medicine in fear of causing thromboembolic complications and rather reoperate to reach hemostasis. Chakravarrty et al, studied the effect of intraoperative tranexamic acid on staple line bleeding, and found that intraoperative prophylactic tranexamic acid use effectively reduces staple line bleeding [ 14 ]. Another study describes their positive experience with tranexamic acid use for reducing staple line bleeding [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…The use of tranexamic acid against staple line bleeding in sleeve gastrectomy has been studied [ 14 , 15 ]. In our hospital, over 500 bariatric procedures are performed annually.…”

Section: Introductionmentioning

confidence: 99%

Tranexamic acid therapy for postoperative bleeding after bariatric surgery

et al. 2018

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BackgroundTranexamic acid reduces blood loss associated with various surgical procedures. Postoperative bleeding caused by dissection or bleeding of the enteric staple lines is a well-known complication following bariatric surgery. Reoperation in order to restore hemostasis is frequently necessary (up to 2.5% in literature). The effect of conservative therapy using tranexamic acid for postoperative hemorrhage after bariatric surgery is still very much a novel technique. The aim is to present our results (reoperation rate and thrombo-embolic complication rate) of tranexamic acid therapy for postoperative bleeding after bariatric surgery in comparison to those in existing literature.MethodsWe retrospectively reviewed 1388 patients who underwent bariatric surgery (laparoscopic gastric bypass or laparoscopic gastric sleeve). Use of tranexamic acid, reoperation rate, transfusion rate and rate of thrombo-embolic complications were reviewed.ResultsForty-five of 1388 (3.2%) total patients experienced significant hemorrhage after bariatric surgery. Tranexamic acid was administered in 44 of these patients. A failure of the treatment with tranexamic acid was observed in four patients. The incidence of reoperation was 0.4% for the entire population. No thrombo-embolic complications were registered for patients receiving tranexamic acid.ConclusionThese findings suggest that the administration of tranexamic acid appears to be safe in reducing the reoperation rate for bleeding after bariatric surgery.

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“… 39 The use of tranexamic acid as a routine intraoperative method of reducing hemorrhage has been proposed. 40 …”

Section: Discussionmentioning

confidence: 99%

Standardised Sleeve Gastrectomy Without Reinforcement

Lynn

Ilczyszyn

Aguilo

et al. 2018

JSLS

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Background and Objectives:Laparoscopic sleeve gastrectomy (LSG) has some unique complications, the most concerning of which is sleeve leak. Staple line reinforcement (SLR) has been suggested as a means of decreasing the risk of sleeve leak, but it increases the cost. However, there is little in the literature regarding the effect of standardized operative technique in reducing the complications and improving the outcomes in LSG. We sought to demonstrate that standardization of the operative procedure and perioperative care is the key to an excellent 30-day outcome and that SLR is not necessary to ensure a negligible staple line leak and bleeding rate.Methods:A prospectively maintained database was analyzed to identify 303 consecutive patients undergoing LSG between July 2010 and November 2017. Data on patient demographics, length of hospital stay, conversion to open surgery, perioperative complications, and mortality were analyzed. Standardized operative technique and postoperative protocol were followed in all cases. SLR was not used in any case.Results:Among 303 cases, there were 15 complications (5%), 5 (1.7%) of which were severe (Clavien-Dindo grade ≥3a). There were no conversions to open procedure, no staple line leaks, and no inpatient deaths in the cohort. No patient was readmitted with an early stricture.Conclusions:The use of a standardized operative and postoperative protocol led to an excellent early outcome in our LSG cases. Standardization may act to obviate the need for routine SLR techniques which are associated with a significant financial cost to both patient and hospital.

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Staple Line Bleeding in Sleeve Gastrectomy—a Simple and Cost-Effective Solution

Abstract: Intraoperative prophylactic tranexemic acid use is a simple and economical option for effectively reducing staple line bleeds leading to significant decrease in operating times.

Cited by 41 publications

References 38 publications

What Makes Bariatric Operations Difficult–Results of a National Survey

What Makes Bariatric Operations Difficult–Results of a National Survey

Tranexamic acid therapy for postoperative bleeding after bariatric surgery

Standardised Sleeve Gastrectomy Without Reinforcement

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