Staple Line Reinforcement Methods in Laparoscopic Sleeve Gastrectomy: Comparison of Burst Pressures and Leaks

Abstract

Background and Objectives:Laparoscopic sleeve gastrectomy is a technically simple and popular bariatric operation with acceptable results. However, leaks can occur in long staple lines, for which various reinforcement methods are used. We compared nonreinforced stapling in laparoscopic sleeve gastrectomy with 3 staple line reinforcement methods: suturing, absorbable buttressing material, and fibrin glue.Methods:From March 1 until September 30, 2014, 118 patients with body mass index >40 kg/m2 underwent sleeve gastrectomy and were enrolled in 4 groups, depending on the type of reinforcement used. The resected stomach specimens were treated with the same methods of reinforcement as used in the surgeries in the corresponding patients and then insufflated until a burst occurred. The burst pressures of the resected stomach specimens and adverse postoperative events were recorded.Results:Five postoperative leaks occurred in the reinforcement groups (fibrin glue, 2; absorbable buttresses, 2; sutures, 1); no leaks were evident in the no-reinforcement group. Suturing afforded the highest burst pressure and took the longest to perform of the methods. There was no correlation between the leaks and burst pressures. All of the leaks occurred in the proximal fundus in the resected stomach specimens and in the affected patients.Discussion:Although most surgeons use additional reinforcement on long staple lines in sleeve gastrectomy, there is no consensus about its necessity. We did not show any benefit of such reinforcement methods over proper stapling technique alone.Conclusion:Laparoscopic sleeve gastrectomy without staple line reinforcement is safe and avoids additional costs for reinforcement materials.

Leaks after laparoscopic sleeve gastrectomy: overview of pathogenesis and risk factors

“…Suturing afforded the highest burst pressure (mean pressure 74.9 mmHg) and took the longest to perform among the methods but there was no correlation between the leaks and burst pressures. All leaks in the patients were detected in the proximal stomach within 5 cm of the GE junction [41]. In our opinion, the most important bias was the evaluation of burst pressure in the resected stomach which is a structure too much different from the sleeve.…”

“…A recent study published by Aydin et al [41] evaluates the burst pressures of the resected stomach specimens and adverse postoperative events. The authors divided the measurements based on the preferred type of staple line reinforcement; group I: 25 patients, no reinforcement (NoR); group II: 26 patients, fibrin glue (FG) (Tissell; Baxter International, Deerfield, Illinois); group III: 44 patients, suture reinforcement with 2-0 polypropylene sutures (S); and group IV: 14 patients, the biological buttressing material Peri-Strip Dry (PS) (Baxter International).…”

Surgical glue in laparoscopic sleeve gastrectomy: An initial experience and cost‐effectiveness analysis

“…Several strategies, including the use of glue, have been used to prevent and decrease complications and also to manage them when they occur. [11][12][13][14] This observational comparative study suggests that using surgical glue during LSG is associated with a reduced duration of operation and a reduced inpatient total cost. The average cost to avoid a severe complication with the glue is significantly negative.…”

Comparison of bursting pressure on sleeve gastrectomy staple lines between stapling, buttressing, and oversewing

“…Furthermore, similar results were reported by Timucin Aydin et al; they showed the highest burst pressure in the oversewed resected stomach. 12 However, they used the whole resected stomach, with the fundus, whereas in the present study, the gastric specimen was resected a second time to achieve a similar diameter of the LSG. We could speculate that the effects we found are promoted by the fact that the sero-serosal invagination creates a “chamber-like” above the whole staple line.…”