title: Integrated bioabsorbable tissue reinforcement in laparoscopic sleeve gastrectomy.
abstract: Division of the stomach in laparoscopic sleeve gastrectomy may be performed using bare stapler cartridges or cartridges fitted with tissue reinforcement strips, with or without oversewing. Many tissue reinforcement strips are after-market add-on products that must be fitted onto a stapler during surgery. A retrospective review was conducted of 85 consecutive patients undergoing laparoscopic sleeve gastrectomy using a novel integrated bioabsorbable polymer buttress pre-mounted on a single-use loading unit stapler. Mean preoperative body mass index (BMI) was 41.7 ± 5.2 kg/m(2). Morbidity and short-term outcomes were documented. Mean follow-up was 8.1 ± 3.6 months (range, 1.0-16.2 months). There were no mortalities or staple line leaks noted in this series with short-term follow up. The major complication rate (grade III and above) was 7.1% and included: reoperation for staple line bleeding (2.4%, n = 2), gastric sleeve stenosis requiring balloon dilation (2.4%, n = 2), choledocholithiasis 2 weeks after surgery (1.2%, n = 1), and reoperation without abnormality for suspected perioperative obstruction (1.2%, n = 1). Mean percent excess BMI loss at 3 (44.6 ± 11.3), 6 (57.9 ± 17.2), and 12 months (72.4 ± 27.5) was comparable to other published series. The use of an integrated absorbable synthetic polymer for stapled tissue reinforcement in laparoscopic sleeve gastrectomy appears to be feasible and safe, and yields results consistent with other published techniques.
authors.affiliation: Department of Surgery, San Antonio Military Medical Center, 59th SSS/SGO2G, Lackland AFB/Fort Sam Houston, San Antonio, TX, USA. joshalleymd@hotmail.com
authors.forename: Joshua B
authors.initials: JB
authors.lastname: Alley
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Fenton
authors.forename: Michael C
authors.initials: MC
authors.lastname: Harnisch
authors.forename: Michael N
authors.initials: MN
authors.lastname: Angeletti
authors.forename: Richard M
authors.initials: RM
authors.lastname: Peterson
mesh_terms: D020341:Absorbable Implants; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D017792:Surgical Stapling; D013537:Sutures; D016896:Treatment Outcome; D015431:Weight Loss