title: Use of staple-line reinforcement in laparoscopic gastric bypass surgery: a meta-analysis.
abstract: OBJECTIVE
  This article was designed to systematically analyze the prospective, randomized, controlled trials on the effectiveness of staple-line reinforcement (SLR) in patients undergoing laparoscopic gastric bypass (LGBP) surgery.
  
  
  METHODS
  Trials on the effectiveness of SLR in patients undergoing LGBP surgery were selected electronic data bases and analyzed to generate summative data by using the principles of meta-analysis on statistical software package RevMan 5.0.2 provided by Cochrane Collaboration. Combined outcome of the binary variables was expressed as odds ratio (OR) and continuous variables were expressed as standardized mean difference (SMD).
  
  
  RESULTS
  Three randomized, controlled trails on 180 patients qualified for inclusion. There were 91 patients in SLR group and 89 patients in non-staple-line reinforcement (NSLR) group. There was no heterogeneity among trials. In the fixed-effects model, SLR is equivalent to NSLR in terms of controlling bleeding (odds ratio (OR), 0.32; 95% confidence interval (CI), 0.03, 3.18; z = 0.98; P < 0.33) from the staple-line and total number of staples used (standardized mean difference (SMD), -21.01; 95% CI, -56.46, 14.44; z = 1.16; P < 0.25) for anastomosis. SLR significantly reduces operative time (SMD, -0.76; 95% CI, -1.36, -0.16; z = 2.47; P < 0.01), perioperative complications (OR, 0.19; 95% CI, 0.05, 0.68; z = 2.55; P < 0.01), anastomotic leak (OR, 0.1; 95% CI, 0.01, 0.78; z = 2.2; P < 0.03), and hemostatic clips (SMD, -21.01; 95% CI, -56.46, 14.44; z = 1.16; P < 0.25) usage.
  
  
  CONCLUSIONS
  SLR seems to reduce the operative time in LGBP. In addition, SLR is associated with fewer postoperative complications, reduced incidence of anastomotic leak, and reduced requirement of hemostatic clips to control hemorrhage at the staple line. However, SLR does not have any superiority in terms of controlling staple-line bleeding and does not influence the number of staples used in LGBP.
authors.affiliation: Department of Surgery, Worthing Hospital, Worthing, West Sussex BN11 2DH, UK. surgeon1wrh@hotmail.com
authors.forename: M S
authors.initials: MS
authors.lastname: Sajid
authors.forename: K
authors.initials: K
authors.lastname: Khatri
authors.forename: K
authors.initials: K
authors.lastname: Singh
authors.forename: M
authors.initials: M
authors.lastname: Sayegh
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000453:epidemiology / Q000517:prevention & control; D016063:Blood Loss, Surgical; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D005747:Gastric Fistula / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000517:prevention & control; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D013525:Surgical Instruments / Q000706:statistics & numerical data; D017792:Surgical Stapling / Q000379:methods*; D013529:Surgical Wound Dehiscence / Q000453:epidemiology / Q000517:prevention & control; D013537:Sutures / Q000706:statistics & numerical data; D016896:Treatment Outcome