title: Staple Line Reinforcement with Stitch in Laparoscopic Sleeve Gastrectomies. Is It Useful or Harmful?
abstract: BACKGROUND
  Reinforcement of the staple line in laparoscopic sleeve gastrectomy (LSG) is a practice that leads to less morbidity, but equivocal results have been reported in the literature.
  
  
  METHODS
  This is a prospective randomized study comparing two groups of patients who underwent LSG. In one group LSG was performed with a running absorbable suture placement at the staple line. In the other group the running suture was not placed. General data of the patients, as well as intraoperative and postoperative data, were gathered and statistically analyzed.
  
  
  RESULTS
  Overall, 146 patients were subjected to LSG. In 84 patients a running suture was placed, and in 62 patients no suture was placed. No significant differences were found between the two groups in demographic data. No significant differences were found also in the intraoperative data, such as number of trocars, number and type of cartridges, drain placement, and operative time (45±21 versus 40±20 minutes, respectively; P<.05). Intraoperative complications were significantly more in the group with the suture placement (33.3% versus 16.1%, respectively; P<.05). Hematomas developed intraoperatively in more patients after the placement of the running suture (9.5% versus 0.0%, respectively; P<.05). Postoperatively, there was no significant difference in morbidity between the two groups (8.3% versus 9.7%, respectively; P>.05).
  
  
  CONCLUSIONS
  After this randomized study, final conclusions about the efficacy of this running suture to the staple line cannot be made. To the contrary, problems seem to exist after such reinforcement of the staple line, such as hematomas. Dealing with possible leaks and hemorrhage of the staple line is also problematic after placement of the running suture.
authors.affiliation: Endoscopic Surgery Department, A Propaideutic Surgical Clinic, University of Athens , Hippokration Hospital of Athens, Athens, Greece .
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Albanopoulos
authors.affiliation: Endoscopic Surgery Department, A Propaideutic Surgical Clinic, University of Athens , Hippokration Hospital of Athens, Athens, Greece .
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tsamis
authors.affiliation: Endoscopic Surgery Department, A Propaideutic Surgical Clinic, University of Athens , Hippokration Hospital of Athens, Athens, Greece .
authors.forename: Aggeliki
authors.initials: A
authors.lastname: Arapaki
authors.affiliation: Endoscopic Surgery Department, A Propaideutic Surgical Clinic, University of Athens , Hippokration Hospital of Athens, Athens, Greece .
authors.forename: Eleftheria
authors.initials: E
authors.lastname: Kleidi
authors.affiliation: Endoscopic Surgery Department, A Propaideutic Surgical Clinic, University of Athens , Hippokration Hospital of Athens, Athens, Greece .
authors.forename: Georgios
authors.initials: G
authors.lastname: Zografos
authors.affiliation: Endoscopic Surgery Department, A Propaideutic Surgical Clinic, University of Athens , Hippokration Hospital of Athens, Athens, Greece .
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Leandros
mesh_terms: D000328:Adult; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006406:Hematoma / Q000209:etiology*; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D061646:Operative Time; D011184:Postoperative Period; D011446:Prospective Studies; D017792:Surgical Stapling / Q000009:adverse effects / Q000379:methods*; D013537:Sutures / Q000009:adverse effects; D055815:Young Adult