title: Staple-line reinforcement with a thrombin matrix during laparoscopic sleeve gastrectomy for morbid obesity: a case series.
abstract: BACKGROUND
  Laparoscopic sleeve gastrectomy (LSG) represents a valid option for morbidly obese patients, either as a primary or as a staged procedure. Staple-line reinforcement (SLR) is strongly advocated to decrease the chance of bleeding. The aim of this article is to report our experience with a new technique of SLR using a thrombin-gelatin matrix in a series of morbidly obese patients subjected to LSG.
  
  
  METHODS
  Patients subjected to LSG using a thrombin-gelatin matrix for SLR from April 2010 to April 2011 were included in the study. Each patient's record was registered and prospectively collected for the analysis.
  
  
  RESULTS
  Seventy-four patients were subjected to LSG using a thrombin matrix for SLR. There were 56 female and 18 male subjects with a mean age of 44.8 years (range, 16-64 years). Mean preoperative body mass index was 46.2 kg/m(2) (range, 40-72 kg/m(2)). Mean operative time was 74.4 minutes (range, 58-96 minutes). Mean time for application of the thrombin matrix was 4.8 minutes (range, 3.2-6.6 minutes). Mean postoperative hospital stay was 3.4 days (range, 2-62 days). Mean follow-up was 8.2 months (range, 3-12 months). Mean postoperative body mass index was 36.2 kg/m(2) (range, 30-42 kg/m(2)), and mean percentage excess weight loss was 34.2% (range, 28.4%-42.8%). We observed two major postoperative complications (2.7%): One gastric stump leak (1.3%) and one major bleeding from the trocar site (1.3%), both successfully treated by laparoscopic re-exploration.
  
  
  CONCLUSIONS
  LSG with a thrombin matrix for SLR is a safe operation and a valid alternative to other well-established techniques.
authors.affiliation: Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy. gentilp@yahoo.com
authors.forename: Paolo
authors.initials: P
authors.lastname: Gentileschi
authors.forename: Stefano
authors.initials: S
authors.lastname: D'Ugo
authors.forename: Domenico
authors.initials: D
authors.lastname: Benavoli
authors.forename: Achille L
authors.initials: AL
authors.lastname: Gaspari
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005781:Gelatin Sponge, Absorbable / Q000627:therapeutic use*; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D017792:Surgical Stapling / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: C411004:FloSeal Matrix