The efficacy of staple line reinforcement during laparoscopic sleeve gastrectomy: A meta-analysis of randomized controlled trials

Wang, Zhaoming; Dai, Xiaoyu; Xie, Haibin; Jin, Feng; Li, Zhong; Lu, Qianqian

doi:10.1016/j.ijsu.2015.12.007

Cited by 70 publications

(30 citation statements)

References 24 publications

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“…The results of our study advise against a distance to the pylorus <5 cm from the first stapling as it is associated with increased mortality; however, other authors recommend starting the section close to the pylorus to achieve greater weight loss [36]. In our study, the use of bioabsorbable polyglycolic acid reinforcement materials proved to be a protective factor for bleeding but had no impact on fistulas; similarly, other studies have shown a reduction in bleeding [37,38], but the reduction in fistulas is subject to controversy [39][40][41]35]. As for RF for mortality, anticoagulant treatment, DM2, smoking, and the distance to the pylorus from the first stapling <5 cm were independent factors; however, the variables that had the most influence on mortality were fistula and pulmonary thromboembolism.…”

Section: Discussionmentioning

confidence: 45%

Prognostic Factors for Morbimortality in Sleeve Gastrectomy. The Importance of the Learning Curve. A Spanish-Portuguese Multicenter Study

Sánchez-Santos¹,

Codina

Vilallonga

et al. 2016

OBES SURG

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Section: Discussionmentioning

confidence: 45%

Prognostic Factors for Morbimortality in Sleeve Gastrectomy. The Importance of the Learning Curve. A Spanish-Portuguese Multicenter Study

Sánchez-Santos¹,

Codina

Vilallonga

et al. 2016

OBES SURG

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“…A meta-analysis of RCTs and a proportion meta-analysis addressed the topic of staple line reinforcement [94,95]. Staple line reinforcement was associated with a 30% lower risk for complications overall (RR 0.7, 95% CI 0.5 to 0.9) and this finding was associated with high certainty.…”

Section: Justificationmentioning

confidence: 99%

Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP

et al. 2020

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Background Surgery for obesity and metabolic diseases has been evolved in the light of new scientific evidence, long-term outcomes and accumulated experience. EAES has sponsored an update of previous guidelines on bariatric surgery. Methods A multidisciplinary group of bariatric surgeons, obesity physicians, nutritional experts, psychologists, anesthetists and a patient representative comprised the guideline development panel. Development and reporting conformed to GRADE guidelines and AGREE II standards. Results Systematic review of databases, record selection, data extraction and synthesis, evidence appraisal and evidence-todecision frameworks were developed for 42 key questions in the domains Indication; Preoperative work-up; Perioperative management; Non-bypass, bypass and one-anastomosis procedures; Revisional surgery; Postoperative care; and Investigational procedures. A total of 36 recommendations and position statements were formed through a modified Delphi procedure. and Other Interventional Techniques Disclaimer This clinical practice guideline has been developed under the auspice of the European Association for Endoscopic Surgery (EAES). It is intended to be used primarily by health professionals (e.g. surgeons, anesthetists, physicians) and to assist in making informed clinical decisions on diagnostic measures and therapeutic management. It is also intended to inform individual practice of allied health professionals (e.g. surgical nurses, dietitians, physical rehabilitation therapists, psychologists); to inform strategic planning and resource management by healthcare authorities (e.g. regional and national authorities, healthcare institutions, hospital administration authorities); and to inform patients wishing to obtain an overview of the condition of interest and its management. The use of recommendations contained herein must be informed by supporting evidence accompanying each recommendation and by research evidence that might not have been published by the time of writing the present document. Users must thus base their actions informed by newly published evidence at any given point Electronic supplementary material The online version of this article (

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“…These results were reported in multiple randomized controlled trials which demonstrated that the staple-line reinforcement in LSG had benefits over the postoperative staple-line hemorrhage and leakage. [17][18][19][20][21] Aggrwal et al and Sroka et al suggested that the diminished bleeding rate after oversewed LSG may be attributed to the learning curve effect and not only the efficacy of oversewing. 18,20 Miller et al and Kasalicky et al stated that the low hemorrhage rate with the buttressing material usage could be related to the more compression during tissue excision.…”

Section: Discussionmentioning

confidence: 99%

Staple line reinforcement during laparoscopic sleeve gastrectomy: pros and cons

Abdelmageed

Helmy

2019

Int Surg J

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Background: Nowadays, laparoscopic sleeve gastrectomy (LSG) is the most common performed bariatric procedure. Staple line reinforcement (SLR) advised for reducing gastric leaks and bleeding after LSG. The aim of this study is to evaluate the efficacy of SLR in reducing the postoperative complications compared to non-SLR during LSG.Method: Sixty morbid obese patients were scheduled for LSG in this prospective randomized study at Sohag University Hospital in the period between March 2016 to February 2018. Patients were divided randomly into two groups: Group I included 30 patients underwent LSG with over sewing of the staple line with running suture using VLoc™ V 3/0 suture. Group II underwent LSG without SLR (n=30).Results: No cases with leaks or stenosis were detected in our series. The operative time was significantly longer in the SLR group compared to the non-SLR group (125 (110-160) vs 100 (90-125) minutes respectively, p<0.01). Staple line bleeding was detected postoperatively only in one case in group II (3.3%) which was treated conservatively. The length of hospital stay was longer in the non-reinforcement group but not significantly different (p=0.25).Conclusions: Staple line reinforcement during LSG has no superiority on the outcome of this operation, used by surgeons as a personal preference and as a security shield rather than for its advantages.

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The efficacy of staple line reinforcement during laparoscopic sleeve gastrectomy: A meta-analysis of randomized controlled trials

Cited by 70 publications

References 24 publications

Prognostic Factors for Morbimortality in Sleeve Gastrectomy. The Importance of the Learning Curve. A Spanish-Portuguese Multicenter Study

Prognostic Factors for Morbimortality in Sleeve Gastrectomy. The Importance of the Learning Curve. A Spanish-Portuguese Multicenter Study

Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP

Staple line reinforcement during laparoscopic sleeve gastrectomy: pros and cons

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