title: The efficacy of staple line reinforcement during laparoscopic sleeve gastrectomy: A meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  This study was performed to evaluate the effects of staple line reinforcement during laparoscopic sleeve gastrectomy.
  
  
  METHODS
  Relevant articles published in English (up to July 25, 2015) were identified by searching PubMed, Embase, Web of Knowledge. The outcomes of staple line hemorrhage and leakage, overall complications, operative time were pooled. Data synthesis and statistical analysis were performed using Stata 13.1 software.
  
  
  RESULTS
  Eight randomized controlled trials involving 791 patients (453 cases and 338 controls) were analyzed. Compared to performing no reinforcement, staple line reinforcement was associated with a lower risk of staple line hemorrhage (RR = 0.609, 95%CI = 0.439-0.846, P = 0.003) and overall complications (RR = 0.673, 95%CI = 0.507-0.892, P = 0.006). No significant difference was observed regarding postoperative leakage (RR = 0.654, 95%CI = 0.275-1.555, P = 0.337). Oversewing of the staple line took longer operative time (WMD = 13.211, 95%CI = 6.192-20.229, P = 0.000).
  
  
  CONCLUSIONS
  Staple line reinforcement using buttressing or roofing materials could reduce staple line hemorrhage and overall complications. No obvious advantages of oversewing the staple line were found and it took longer operative time. No significant reduction in leak rate was evidenced after reinforcement.
authors.affiliation: Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China. Electronic address: fengdun@hotmail.com.
authors.forename: Zhaoming
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China.
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Dai
authors.affiliation: Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China.
authors.forename: Haibin
authors.initials: H
authors.lastname: Xie
authors.affiliation: Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Feng
authors.affiliation: Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China.
authors.forename: Zhong
authors.initials: Z
authors.lastname: Li
authors.affiliation: Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China. Electronic address: changyiluqicheng@sina.com.
authors.forename: Qicheng
authors.initials: Q
authors.lastname: Lu
mesh_terms: D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D061646:Operative Time; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D017792:Surgical Stapling / Q000009:adverse effects / Q000379:methods*
keywords: Laparoscopic; Reinforcement; Sleeve gastrectomy