Comparative use of different techniques for leak and bleeding prevention during laparoscopic sleeve gastrectomy: a multicenter study.
BACKGROUND
Laparoscopic sleeve gastrectomy (LSG) is an approved primary procedure for morbid obesity, but it is associated with serious complications, such as staple line leaks and bleeding. The objective of this study was to assess the effectiveness of staple line reinforcement (SLR) in reducing leaks and bleeding after LSG.


METHODS
A total of 1162 patients underwent LSG (305 males, 857 females). The mean age was 43.7 years and the mean body mass index was 48 kg/m(2). The patients were divided into 6 groups based on the type of SLR, including a no-SLR control group, with evaluation of leaking and bleeding risk and correlation of patients' characteristics with complications.


RESULTS
A total of 189 patients underwent LSG without reinforcement. The SLR method was oversewing in 476 patients, bovine pericardium in 312, synthetic polyester in 76, glycolide/trimethylene copolymer in 63, and thrombin matrix in 46. The overall leak frequency was 2.8%; higher with synthetic polyester (7.8%), 4.8% with no reinforcement, and lower with bovine pericardium strips (.3%; P<.01). Postoperative hemorrhage occurred in 35 patients (3%), with a higher frequency being observed without SLR (13.7%; P = .02). Only diabetes was a risk-factor for a leak (P< .01).


CONCLUSIONS
SLR with bovine pericardium strips significantly reduced the leak risk. Postoperative bleeding was significantly lower with all SLR-methods, although there was no significant difference among the various techniques. Patients with type II diabetes had a higher risk of staple line leak after LSG. Further randomized, controlled studies are needed to improve our understanding of the efficacy of SLR during LSG.
Bariatric Surgery Unit - Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy. Electronic address: dugo.stefano@gmail.com.
Stefano
S
D'Ugo
Bariatric Surgery Unit - Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy.
Paolo
P
Gentileschi
Bariatric Surgery Unit - Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy.
Domenico
D
Benavoli
Bariatric Surgery Unit - Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy.
Michela
M
Cerci
Bariatric Surgery Unit - Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy.
Achille
A
Gaspari
Bariatric and Metabolic Surgery Unit - Azienda Ospedaliera-Universitaria Pisana, Pisa, Italy.
Rossana Daniela
RD
Berta
Bariatric and Metabolic Surgery Unit - Azienda Ospedaliera-Universitaria Pisana, Pisa, Italy.
Carlo
C
Moretto
Bariatric and Metabolic Surgery Unit - Azienda Ospedaliera-Universitaria Pisana, Pisa, Italy.
Rosario
R
Bellini
VII Department of Surgery - La Sapienza University, Rome, Italy.
Nicola
N
Basso
VII Department of Surgery - La Sapienza University, Rome, Italy.
Giovanni
G
Casella
VII Department of Surgery - La Sapienza University, Rome, Italy.
Emanuele
E
Soricelli
Department of General Surgery - S. Giovanni Bosco Hospital, Naples, Italy.
Pierpaolo
P
Cutolo
Department of General Surgery - S. Giovanni Bosco Hospital, Naples, Italy.
Giampaolo
G
Formisano
Department of General Surgery - S. Giovanni Bosco Hospital, Naples, Italy.
Luigi
L
Angrisani
Bariatric and Metabolic Surgery Unit - Azienda Ospedaliera-Universitaria Pisana, Pisa, Italy.
Marco
M
Anselmino
D000293:Adolescent; D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000453:epidemiology / Q000517:prevention & control*; D000818:Animals; D015992:Body Mass Index; D002417:Cattle; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D015391:Gastroplasty / Q000009:adverse effects / Q000379:methods*; D064593:Heterografts; D006801:Humans; D015994:Incidence; D007432:Intraoperative Period; D007558:Italy; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000637:transplantation; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D013536:Suture Techniques / Q000295:instrumentation*; D016896:Treatment Outcome; D055815:Young Adult
Bariatric surgery; Bleeding; Leak; Sleeve gastrectomy; Staple line reinforcement