title: Are there risk factors that increase the rate of staple line leakage in patients undergoing primary sleeve gastrectomy for morbid obesity?
abstract: BACKGROUND
  Laparoscopic sleeve gastrectomy (LSG) is currently being performed with increasing frequency worldwide. It offers an excellent weight loss and resolution of comorbidities in the short term with a very low incidence of complications. However, the ever present risk of a staple line leak is still a major concern.
  
  
  METHODS
  Since 2005, data from obese patients that undergo bariatric procedures in Germany are prospectively registered in an online database and analyzed at the Institute of Quality Assurance in Surgical Medicine. For the current analysis, all patients that had undergone primary sleeve gastrectomy for morbid obesity within a 7-year period were considered.
  
  
  RESULTS
  Using the GBSR, data from 5.400 LSGs were considered for analysis. Staple line leak rate decreased during the study period from 6.5 to 1.4 %. Male gender, higher BMI, concomitant sleep apnea, conversion to laparotomy, longer operation time, use of both buttresses and oversewing, and the occurrence of intraoperative complications were associated with a significantly higher leakage rate. On multivariate analysis, operation time and year of procedure only had a significant impact on staple line leak rate.
  
  
  CONCLUSIONS
  The results of the current study demonstrated that there are factors that increase the risk of a leakage which would enable surgeons to define risk groups, to more carefully select patients, and to offer a closer follow-up during the postoperative course with early recognition and adequate treatment. All future efforts should be focused on a further reduction of serious complications to make the LSG a widely accepted and safer procedure.
authors.affiliation: Department of Surgery, University Hospital Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany, frankbenedix@gmx.de.
authors.forename: Frank
authors.initials: F
authors.lastname: Benedix
authors.forename: Diana D
authors.initials: DD
authors.lastname: Benedix
authors.forename: Christian
authors.initials: C
authors.lastname: Knoll
authors.forename: Rudolf
authors.initials: R
authors.lastname: Weiner
authors.forename: Christiane
authors.initials: C
authors.lastname: Bruns
authors.forename: Thomas
authors.initials: T
authors.lastname: Manger
authors.forename: Christine
authors.initials: C
authors.lastname: Stroh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D017792:Surgical Stapling / Q000009:adverse effects* / Q000379:methods; D015431:Weight Loss; D055815:Young Adult
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