Staple-line reinforcement with bovine pericardium in laparoscopic sleeve gastrectomy: experimental comparative study in pigs.
BACKGROUND
We studied the usefulness of Bovine Pericardial strips (BPS) as a buttress in the prevention of complications from the gastric staple-line in laparoscopic sleeve gastrectomy (LSG).


METHODS
LSG was carried out in 18 pigs. Resection of the stomach was performed with 4.8-mm/30-mm linear stapler either without (Control Group--n = 9) or with BPS (Buttress Group--n = 9). Intra- and postoperative blood losses were assessed. Leaks were evaluated with methylene blue test intra-operatively and then clinically. The animals were sacrificed 2 weeks after surgery and the abdominal cavity was evaluated for fluid collections and adhesions, and the burst pressure of the stomach was measured and histopathological study of the staple-line was performed. Student t-test was used for statistical analysis.


RESULTS
No leaks were detected except for one small subclinical leak in the buttress group. Internal ulcers at the staple-line were seen more frequently in the Buttress group (6 vs 3, not significant). There was no significant difference between the two groups with regards to operative time (65.3 +/- 14.2 min, 69.7 +/- 12.8 min), intra-operative bleeding (9.6 +/- 2.2 ml, 8.2 +/- 1.5 ml), postoperative hemoglobin levels (11.3 +/- 1.9 g%, 11.8 +/- 2.2 g%), and burst pressure (152.6 +/- 23.5 mmHg, 161.2 +/- 15.8 mmHg) for the Control and Buttress groups respectively. More intense adhesions and inflammatory response were observed in the Buttress Group.


CONCLUSIONS
In this experimental model, the use of bovine pericardium as a staple-line buttress in LSG was easy and safe; however, it did not decrease the occurrence of complications.
Assalia
Ahmad
A
Department of Surgery B, Rambam Health Care Campus, Haifa, Israel.
Ueda
Kazuki
K
Matteotti
Ronald
R
Cuenca-Abente
Federico
F
Rogula
Tomasz
T
Gagner
Michel
M
D000818:Animals; D002417:Cattle; D005260:Female; D005743:Gastrectomy; D010535:Laparoscopy; D010496:Pericardium / Q000637:transplantation*; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D017792:Surgical Stapling / Q000379:methods*; D013529:Surgical Wound Dehiscence / Q000517:prevention & control*; D013552:Swine; D013718:Tensile Strength; D014183:Transplantation, Heterologous; D016042:Transplantation, Heterotopic