Surgical glue in laparoscopic sleeve gastrectomy: An initial experience and cost-effectiveness analysis.
OBJECTIVE
Laparoscopic sleeve gastrectomy (LSG) is one of the most common bariatric procedures. Gastric leaks and bleeding are the most frequent complications, associated with a high clinical and economic burden. The best method of staple line reinforcement in LSG is debated. Surgical glue is one of the options available. The aim of this study was to assess the safety, efficiency, and relative cost-effectiveness of surgical glue used to perform LSG in morbid obese adults as compared with standard stapling.


METHODS
A prospective, observational, and comparative before-after study was conducted. All consecutive patients undergoing LSG at Montpellier University Hospital in 2011 and 2012 were included and treated according to 2 groups: standard stapling (n = 99, group 1) and surgical glue reinforcement (n = 94, group 2). Clinical and economic outcomes were measured after 6 months.


RESULTS
The duration of intervention was significantly shorter in group 2 (68 vs 82 minutes, P = .001). There was no significant difference regarding complications, but leaks in group 1 were more severe. Group 2 was also associated with a reduced initial length of stay (4.8 vs 5.2 days, P = .01). Six-month readmissions and total length of stay were also shorter in group 2 (5.5 vs 6.1 days, P = .003). Surgical glue use was associated with a significant reduction in the initial inpatient cost (€5488 vs €6152, P = .005) and in the 6-month total inpatient cost, including readmissions (€6006 vs €6754, P = .005). The incremental cost of glue to avoid a severe complication was -€5446.33 (95 confidence interval, -8202.01 to -2690.66).


CONCLUSIONS
Surgical glue might be a safe and cost-effective intervention in laparoscopic sleeve gastrectomy.
Department d'Information Médicale, CHU de Montpellier, Montpellier, France.|UMR LAMETA, Université de Montpelier, Montpellier, France.
Gregoire
G
Mercier
Departamento de Biotecnologia, Universidade Positivo, Curitiba, Brazil.|Université Montpellier 1, Montpellier, France.|CHU de Montpellier, Montpellier, France.
Marcelo
M
Loureiro
Department d'Information Médicale, CHU de Montpellier, Montpellier, France.
Vera
V
Georgescu
CHU de Montpellier, Montpellier, France.
El Mehdi
EM
Skalli
CHU de Montpellier, Montpellier, France.
Marius
M
Nedelcu
CHU de Montpellier, Montpellier, France.
Mohamed
M
Ramadan
Université Montpellier 1, Montpellier, France.|CHU de Montpellier, Montpellier, France.
Jean Michel
JM
Fabre
Université Montpellier 1, Montpellier, France.|CHU de Montpellier, Montpellier, France.
Patrick
P
Lefebvre
Université Montpellier 1, Montpellier, France.|CHU de Montpellier, Montpellier, France.
David
D
Nocca
D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D010359:Patient Readmission; D011446:Prospective Studies; D017792:Surgical Stapling / Q000191:economics / Q000379:methods; D000071062:Sutureless Surgical Procedures / Q000191:economics* / Q000379:methods*; D014014:Tissue Adhesives / Q000191:economics*
D014014:Tissue Adhesives
bariatric surgery; cost; effectiveness; glue; obesity; sleeve