Decreased bleeding after laparoscopic sleeve gastrectomy with or without duodenal switch for morbid obesity using a stapled buttressed absorbable polymer membrane.
BACKGROUND
Laparoscopically performed sleeve gastrectomy may be employed as an adjunct to biliopancreatic diversion with duodenal switch (BPD-DS), to induce early satiety and weight loss in morbidly obese patients. Complications from this gastric procedure include staple-line leakage or hemorrhage. The efficacy of a staple-line buttressing material, an absorbable polymer membrane (Seamguard, Gore), in reducing these complications, was investigated.


METHODS
A prospective consecutive series of 20 patients who underwent a laparoscopic sleeve gastrectomy in conjunction with BPD-DS were studied. In 10 patients, the absorbable polymer membrane was integrated into the gastric linear staple-line (group A). In a control group of 10 patients, a conventional linear stapling system was used (group B). The following data were recorded: demographics, intraoperative blood loss, staple-line leakage and hospital stay.


RESULTS
Demographic profile was similar in both groups. Operative data, including type, duration and strategy of operation as well as surgeon's experience were well matched. Peroperative blood loss (120 ml vs 210 ml) was significantly higher in group B (P <0.05). Median length of hospital stay was 3.8 days (range 2-8 days) in group A and 4.6 days (range 4-12 days) in group B. There was no mortality. Morbidity was encountered in 3 patients (all group B), including 2 staple-line hemorrhages (10%) and 1 subphrenic abscess (5%).


CONCLUSIONS
These early results may show that Seamguard reduces staple-line hemorrhage and leakage. This may have contributed to shorter hospital stay, decreased costs and lower morbidity after laparoscopic bariatric surgery.
Consten
Esther C J
EC
Department of Surgery, Weill-New York-Presbyterian Hospital, College of Medicine of Cornell University, New York, NY 10021, USA.
Gagner
Michel
M
Pomp
Alfons
A
Inabnet
William B
WB
D020341:Absorbable Implants; D000328:Adult; D000713:Anastomosis, Roux-en-Y; D015904:Biliopancreatic Diversion / Q000009:adverse effects / Q000379:methods*; D015992:Body Mass Index; D004386:Duodenum / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D011108:Polymers; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017792:Surgical Stapling / Q000379:methods; D013536:Suture Techniques; D013537:Sutures; D016896:Treatment Outcome
D011108:Polymers