title: The effects of reinforcement methods on burst pressure in resected sleeve gastrectomy specimens.
abstract: BACKGROUND
  Staple-line leak is a life-threatening complication of laparoscopic sleeve gastrectomy. Reinforcement materials have been reported to lower the risk of staple-line bleeding, but their effects on leak risk have not been elucidated. The aim of this study was to compare the effects of two supportive techniques on burst pressures in sleeved gastrectomy specimens.
  
  
  METHODS
  Thirty patients who underwent laparoscopic sleeve gastrectomy were evaluated. The resected sleeve gastrectomy specimens were categorized into three groups. Group 1 had no extra support in the staple line, Group 2 had oversewing with continuous suture on the staple line, and Group 3 had fibrin sealant (Tisseel(®); Baxter, Deerfield, IL) on the staple line. The end point was the first detectable leakage, at which point leak pressure and the anatomic site of leakage were recorded.
  
  
  RESULTS
  Thirty sleeved gastrectomy specimens were included (each group included 10 specimens). There were no differences among group in terms of age, sex, and body mass index. The leak pressure was significantly higher (106±10.5 mm Hg) in Group 2 (P<.01). Leaks occurred significantly more frequently in the staple line than in the staple junction points (P=.014).
  
  
  CONCLUSIONS
  Oversewing the staple line with 3-0 Vicryl(®) (Ethicon, Somerville, NJ) suture significantly increased the strength of the staple line. Increases in intraluminal pressure are known to be one of the significant risks in leak etiology. Thus, we concluded that oversewing the staple line with 3-0 Vicryl suture can be beneficial in the prevention of leaks. However, further work is necessary in this area of research.
authors.affiliation: 1 Department of General Surgery, Antalya Training and Research Hospital , Antalya, Turkey .
authors.forename: Rojbin
authors.initials: R
authors.lastname: Karakoyun
authors.forename: Umut
authors.initials: U
authors.lastname: Gündüz
authors.forename: Nurullah
authors.initials: N
authors.lastname: Bülbüller
authors.forename: Hasan
authors.initials: H
authors.lastname: Çalış
authors.forename: Mani
authors.initials: M
authors.lastname: Habibi
authors.forename: Osman
authors.initials: O
authors.lastname: Öner
authors.forename: Hakan
authors.initials: H
authors.lastname: Gülkesen
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000517:prevention & control; D004867:Equipment Design; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D011312:Pressure; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000295:instrumentation*; D013537:Sutures; D016896:Treatment Outcome; D055815:Young Adult