title: Staple line reinforcement in laparoscopic bariatric surgery: does it actually make a difference? A systematic review and meta-analysis.
abstract: BACKGROUND
  Staple line leaks represent a major concern in all laparoscopic operations but are particularly important in bariatric surgery, where leak complications carry significant morbidity and mortality. Therefore, several means of staple line reinforcement have been described, but none is totally accepted. In this study, we attempt to illuminate any clear benefit of staple line reinforcement through a systematic review and meta-analysis of reported articles.
  
  
  METHODS
  Two major databases (PubMed and Cochrane) were searched and assessed by two reviewers. Inclusion criteria were: detailed description of operative technique, especially concerning staple line reinforcement, and possible existence of proven staple line leak. Selected studies were evaluated by systematic review and meta-analysis according to their eligibility. The study population was finally divided into two groups: reinforcement (of any type) and no reinforcement.
  
  
  RESULTS
  In the initial search, 126 studies were obtained. Then, 17 full papers, both randomised controlled trials (RCTs) and non-RCTs, were included in the systematic review. Seven studies, comprising 3,299 patients, were examined for evaluation of population odds of leak (7.69), which was considered clinically significant. Meta-analysis of three studies comprising 1,899 patients revealed no clear benefit of reinforcement group, though with marginal significance.
  
  
  CONCLUSIONS
  Although several drawbacks exist, this study illustrates two important aspects: that current staplers may not be uniformly reliable, and that staple line reinforcement does not seem to have any clear benefit, at least concerning leak rate.
authors.affiliation: 2nd Propedeutic Department of Surgery, Laikon Hospital, University of Athens, 2 Apostoli str, Piraeus, Athens, 185 37, Greece. geogianno@hotmail.com
authors.forename: George A
authors.initials: GA
authors.lastname: Giannopoulos
authors.forename: Nikolaos E
authors.initials: NE
authors.lastname: Tzanakis
authors.forename: George E
authors.initials: GE
authors.lastname: Rallis
authors.forename: Stamatis P
authors.initials: SP
authors.lastname: Efstathiou
authors.forename: Christos
authors.initials: C
authors.lastname: Tsigris
authors.forename: Nikolaos I
authors.initials: NI
authors.lastname: Nikiteas
mesh_terms: D000714:Anastomosis, Surgical; D050110:Bariatric Surgery; D057867:Endoleak / Q000517:prevention & control; D006801:Humans; D010535:Laparoscopy; D009767:Obesity, Morbid / Q000601:surgery; D017792:Surgical Stapling
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