title: Laparoscopic sleeve gastrectomy with staple line buttress reinforcement in 116 consecutive morbidly obese patients.
abstract: BACKGROUND
  Obesity rates have reached epidemic levels with over 300 million obese individuals worldwide. Laparoscopic sleeve gastrectomy (LSG) as a primarily restrictive bariatric surgical procedure has been shown to be effective in producing marked weight loss. However, LSG-associated gastric leakage and hemorrhages remain the most important challenges postoperatively. Staple line buttress reinforcement has been suggested to reduce these postoperative complications. Our objective was to assess staple line buttress reinforcement via the Duet™ tissue reinforcement stapler system in morbidly obese patients undergoing LSG as part of a comprehensive weight management strategy, focusing on postoperative complications.
  
  
  METHODS
  Between January 2008 and April 2011, we retrospectively reviewed the medical records of 116 consecutive patients that underwent LSG with staple line buttress reinforcement at an academic teaching hospital with advanced bariatric fellowship.
  
  
  RESULTS
  The mean age of patients was 44.3 ± 9.5 years, with mean preoperative BMI of 44 ± 7 kg/m2. The mean operative time to perform LSG was 96 ± 25 min. Postoperative weight was significantly lower following LSG at 1-year follow-up compared to baseline (104 ± 25 vs. 125 ± 27 kg, P < 0.05). There were no postoperative gastric leaks observed. Postoperative bleeding from the gastric staple line occurred in one patient (0.9%) and was treated with conservative management.
  
  
  CONCLUSIONS
  In LSG, staple line buttress reinforcement limits postoperative gastric leakage and bleeding in morbidly obese patients.
authors.affiliation: Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Richdeep S
authors.initials: RS
authors.lastname: Gill
authors.forename: Noah
authors.initials: N
authors.lastname: Switzer
authors.forename: Mike
authors.initials: M
authors.lastname: Driedger
authors.forename: Xinzhe
authors.initials: X
authors.lastname: Shi
authors.forename: Andrey
authors.initials: A
authors.lastname: Vizhul
authors.forename: Arya M
authors.initials: AM
authors.lastname: Sharma
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Birch
authors.forename: Shahzeer
authors.initials: S
authors.lastname: Karmali
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D002170:Canada / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008499:Medical Records; D009767:Obesity, Morbid / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000379:methods*; D016896:Treatment Outcome; D015431:Weight Loss