title: A systematic review of staple-line reinforcement in laparoscopic sleeve gastrectomy.
abstract: OBJECTIVE
  Laparoscopic sleeve gastrectomy is gaining popularity as a bariatric procedure, with outcomes similar to gastric band and gastric bypass. Staple-line disruption is a significant source of morbidity and death. We aim to evaluate the effect of staple-line reinforcement on the gastric leak rate, morbidity, and mortality rate.
  
  
  METHODS
  A systematic review was performed using title key words "sleeve gastrectomy," and articles were reviewed for description of operative technique and postoperative outcomes including staple-line leak. Rates of leak, bleeding, surgical-site infection, reintervention, readmission, and mortality were analyzed. We calculated pooled event rates and 95% confidence intervals using fixed-effects modeling to determine differences between the reinforcement group (group A) and non-reinforcement group (group B).
  
  
  RESULTS
  We identified 390 articles, and 30 met the inclusion criteria. Group A had 3293 patients, and group B had 1588 patients. After heterogeneity calculations, 9 variables met the criteria to be analyzed. The leak rate was 3.9% (95% confidence interval, 2.9%-5.5%) in group A and 3.2% (95% confidence interval, 2.8%-4.1%) in group B. The mortality rate was 0.8% (95% confidence interval, 0.4%-1.5%) in group A and 0.7% (95% confidence interval, 0.4%-1.1%) in group B. Our results also showed no statistical difference for any of our other 7 outcome variables.
  
  
  CONCLUSIONS
  Our study shows a lack of statistical difference in leak rate, overall morbidity, or mortality rate in laparoscopic sleeve gastrectomy with or without staple-line reinforcement. Because of study limitations, we propose that prospective trials are needed to determine the effect of staple-line reinforcement on leak rates.
authors.affiliation: Department of Surgery, Central Michigan University College of Medicine, 1000 Houghton Avenue, 2nd Floor Saginaw, MI 48602, USA.
authors.forename: Jean
authors.initials: J
authors.lastname: Knapps
authors.forename: Maher
authors.initials: M
authors.lastname: Ghanem
authors.forename: John
authors.initials: J
authors.lastname: Clements
authors.forename: Aziz M
authors.initials: AM
authors.lastname: Merchant
mesh_terms: D057868:Anastomotic Leak / Q000517:prevention & control*; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D017792:Surgical Stapling / Q000379:methods*
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