title: A comparison of a single center's experience with three staple line reinforcement techniques in 1,502 laparoscopic sleeve gastrectomy patients.
abstract: OBJECTIVE
  This study aimed to compare outcomes of laparoscopic sleeve gastrectomy (LSG) patients based on three types of staple line reinforcement (SLR): seromuscular suturing (imbrication), absorbable polymer membrane (APM), and bovine pericardial strips (BPS).
  
  
  BACKGROUND
  LSG represented 67.3 % of bariatric procedures performed in Michigan in 2013, and its prevalence continues to rise. Multiple studies suggest that SLR can potentially reduce the incidence of complications. However, the current literature is limited secondary to a small sample size and is not conclusive on which type of reinforcement technique is best in reducing the risk of complications.
  
  
  METHODS
  The charts of 1,526 consecutive patients who underwent an LSG from January 2005 to January 2013, by four experienced surgeons, were reviewed. Data include patient demographics, reinforcement technique utilized, length of hospitalization, complications, hospital readmission rates, and mortality.
  
  
  RESULTS
  Of 1,502 patients who underwent an LSG and met inclusion/exclusion criteria, 373 (24.8 %) were reinforced using imbrication, 269 (17.9 %) with BPS, and 860 (57.3 %) with APM. Patient demographics and complication rates were similar between groups. A statistically significant difference occurred in length of stay, readmission, and reoperation rates (p < 0.01). Length of stay was shortest in the BPS group, but readmission and reoperation rates were statistically higher, and there was a trend towards increased leaks (p = 0.08).
  
  
  CONCLUSIONS
  A comparison of imbrication, BPS, and APM demonstrated significantly increased readmission and reoperation rates with a trend towards increased leak rates with the use of BPS in LSG patients. Hemorrhage was not statistically different between the three reinforcement techniques.
authors.affiliation: Grand Rapids Medical Education Partners Family Medicine Residency, 300 Lafayette SE, Suite 4000, Grand Rapids, MI, 49503, USA, tyler.barreto@grmep.com.
authors.forename: Tyler W
authors.initials: TW
authors.lastname: Barreto
authors.forename: Paul R
authors.initials: PR
authors.lastname: Kemmeter
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Paletta
authors.forename: Alan T
authors.initials: AT
authors.lastname: Davis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000453:epidemiology / Q000209:etiology; D000818:Animals; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D010359:Patient Readmission; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult