A Narrative of Intraoperative Staple Line Leaks and Bleeds During Bariatric Surgery.
The primary objective of this review was to assess the incidence of intraoperative staple line leaks and bleeds during laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). A literature search of MEDLINE®, EMBASE™, and Biosis from January 2010 to November 2014, plus secondary citations extending to 2008, identified 16 relevant articles. For LSG, the incidence of intraoperative leaks and bleeds was as high as 3.93 and 4.07 %, respectively. For LRYGB, leaks occurred in up to 8.26 % and bleeds in 3.45 % of cases. Stapler misfire was commonly cited as a cause. Widespread, precautionary use of staple line reinforcement (SLR), lack of standardized testing, and underreporting suggest the incidence may be underestimated. Published studies were insufficient to address the economic impact of bleeds and leaks or interventions, but development of improved stapler designs that obviate the need for SLR may reduce costs and improve outcomes.
Global Health Economics and Market Access, Ethicon Inc., 4545 Creek Road ML 96, Cincinnati, OH, USA. sghosh91@its.jnj.com.
Sudip K
SK
Ghosh
Global Health Economics and Market Access, Ethicon Inc., 4545 Creek Road ML 96, Cincinnati, OH, USA.
Sanjoy
S
Roy
Medical Affairs, Ethicon Inc., Cincinnati, OH, USA.
Ed
E
Chekan
Medical Affairs, Ethicon Inc., Cincinnati, OH, USA.
Elliott J
EJ
Fegelman
D000328:Adult; D057868:Anastomotic Leak / Q000453:epidemiology* / Q000209:etiology; D050110:Bariatric Surgery / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D015390:Gastric Bypass / Q000009:adverse effects* / Q000706:statistics & numerical data; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy / Q000706:statistics & numerical data; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000009:adverse effects* / Q000706:statistics & numerical data
Bariatric surgery; Gastric bleed; Gastric bypass; Gastric leak; Intraoperative intervention; Laparoscopic; Sleeve gastrectomy; Staple line