Comparison of Reinforcement Techniques Using Suture on Staple-Line in Sleeve Gastrectomy.
BACKGROUND
Sleeve gastrectomy is a common procedure in recent years for treatment of morbid obesity however leak from staple-line is its main challenging complication. Despite numerous studies regarding leak after sleeve gastrectomy, there is still no conclusion on reinforcement of staple-line in this procedure. The purpose of this study was to compare two methods of oversewing staple-line versus no reinforcement.


METHODS
Resected stomachs of 30 patients undergoing laparoscopic sleeve gastrectomy were evaluated for bursting pressure immediately after extraction from the abdomen. Reinforcement technique was applied in random order to 3 segments of the staple-line on each specimen: continuous Lembert's sutures, continuous through-and-through sutures, and no reinforcement. Bursting pressure was determined by injection of methylene blue solution into lumen of resected stomach and recording pressure at which leakage occurs. Location of leak, intragastric pressure, and volume at first leak were recorded.


RESULTS
Baseline characteristics of patients were similar in randomized groups for order of reinforcement technique. Mean ischemia time of specimens was 17.4 ± 10.4 min. No leaks were observed in segments reinforced with Lembert's oversewing technique. The through-and-through reinforcement segments were first to leak in 21 out of 30 cases (70 %) with mean leak pressure of 570 mmHg and mean leak volume of 399 ml. Leakage occurred in 9 segments (30 %) with no reinforcement with a leak pressure of 329 mmHg and volume of 380 ml.


CONCLUSIONS
In vitro, Lembert's suture reinforcement technique on stapled human stomach is associated with less leakage rate in comparison to through-and-through reinforcement and non-reinforced staple-line.
Cleveland Clinic, Bariatric and Metabolic Institute, 9500 Euclid Ave, M66-06, Cleveland, OH, 44118, USA. tomrogula@gmail.com.
Tomasz
T
Rogula
Cleveland Clinic, Bariatric and Metabolic Institute, 9500 Euclid Ave, M66-06, Cleveland, OH, 44118, USA.
Zhamak
Z
Khorgami
Jagiellonian University Medical College, Krakow, Poland.
Martin
M
Bazan
Jagiellonian University Medical College, Krakow, Poland.
Cristina
C
Mamolea
University of Buenos Aires, Buenos Aires, Argentina.
Pablo
P
Acquafresca
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Omar
O
El-Shazly
Cleveland Clinic, Bariatric and Metabolic Institute, 9500 Euclid Ave, M66-06, Cleveland, OH, 44118, USA.
Ali
A
Aminian
Cleveland Clinic, Bariatric and Metabolic Institute, 9500 Euclid Ave, M66-06, Cleveland, OH, 44118, USA.
Philip
P
Schauer
D000328:Adult; D057868:Anastomotic Leak / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D013270:Stomach / Q000601:surgery*; D017792:Surgical Stapling; D013536:Suture Techniques
Burst pressure; Sleeve gastrectomy; Staple-line leak; Staple-line reinforcement