Abstract
Background
The main drawback of laparoscopic sleeve gastrectomy (LSG) is the severity of postoperative complications. Staple line reinforcement (SLR) is strongly advocated. The purpose of this study was to compare prospectively and randomly three different techniques of SLR during LSG.
Methods
From April 2010 to April 2011, patients submitted to LSG were randomly selected for the following three different techniques of SLR: oversewing (group A); buttressed transection with a polyglycolide acid and trimethylene carbonate (group B); and staple-line roofing with a gelatin fibrin matrix (group C). Primary endpoints were reinforcement operative time, incidence of postoperative staple-line bleeding, and leaks. Operative time was calculated as follows: oversewing time in group A; positioning of polyglycolide acid and trimethylene carbonate over the stapler in group B; and roofing of the entire staple line in group C.
Results
A total of 120 patients were enrolled in the study (82 women and 38 men). Mean age was 44.6 ± 9.2 (range, 28–64) years. Mean preoperative body mass index was 47.2 ± 6.6 (range, 40–66) kg/m². Mean time for SLR was longer in group A (14.2 ± 4.2 (range, 8–18) minutes) compared with group B (2.4 ± 1.8 (range, 1–4) minutes) and group C (4.4 ± 1.6 (range, 3–6) minutes; P < 0.01). Four major complications were observed (3.3 %): one leak and one bleeding in group A; one bleeding in group B; and one leak in group C, with no significant differences between the groups. No mortality was observed.
Conclusions
SLR with either polyglycolide acid with trimethylene carbonate or gelatin fibrin matrix is faster compared with oversewing. No significant differences were observed regarding postoperative staple-line complications.
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References
Ren CJ, Patterson E, Gagner M (2000) Early results of laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients. Obes Surg 10(6):514–523
Frezza EE (2007) Laparoscopic vertical sleeve gastrectomy for morbid obesity. The future procedure of choice? Surg Today 37:275–281
Gumbs AA, Gagner M, Dakin G, Pomp A (2007) Sleeve gastrectomy for morbid obesity. Obes Surg 17:962–969
Brethauer SA, Hammel JP, Schauer PR (2009) Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis 5:469–475
Serra C, Baltasar A, Andreo L, Perez N, Bou R, Bengochea M, Chisbert JJ (2007) Treatment of gastric leaks with coated self-expanding stents after sleeve gastrectomy. Obes Surg 17:866–872
Crookes P (2009) Management of severe reflux after sleeve gastrectomy. In: Abstract of Second International Consensus Summit for Sleeve Gastrectomy, Miami Beach, FL, March 19–21, 2009
Dapri G, Cadière GB, Himpens J (2009) Laparoscopic seromyotomy for long stenosis after sleeve gastrectomy with or without duodenal switch. Obes Surg 19:495–499
Langer FB, Bohdjalian A, Felberbauer FX, Fleischmann E, Reza Hoda MA, Ludvik B, Zacherl J, Jakesz R, Prager G (2006) Does gastric dilatation limit the success of sleeve gastrectomy as a sole operation for morbid obesity? Obes Surg 16:166–171
Gagner M, Gumbs AA, Milone L, Yung E, Goldenberg L, Pomp A (2008) Laparoscopic sleeve gastrectomy for the super-super-obese (body mass index >60 kg/m2). Surg Today 38:399–403
De Csepel J, Burpee S, Jossart G, Andrei V, Murakami Y, Benavides S, Gagner M (2001) Laparoscopic biliopancreatic diversion with a duodenal switch for morbid obesity: a feasibility study in pigs. J Laparoendosc Adv Surg Tech 11:79–83
Baltasar A, Bou R, Miro J, Bengochea M, Serra C, Perez N (2001) Laparoscopic biliopancreatic diversion with duodenal switch: technique and initial experience. Obes Surg 12:245–248
Weiner RA, Blanco-Engert R, Weiner S, Pomhoff I, Schramm M (2004) Laparoscopic biliopancreatic diversion with duodenal switch: three different duodenol-ileal anastomotic techniques and initial experience. Obes Surg 14:334–340
Clinical Issues Committee of American Society for Metabolic and Bariatric Surgery (2009) Updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis. doi:10.1016/j.soard.2009.11.004
Consten ECJ, Gagner M, Pomp A, Inabnet WB (2004) Decreased bleeding after laparoscopic sleeve gastrectomy with or without duodenal switch for morbid obesity using a stapled buttresses absorbable polymer membrane. Obes Surg 14:1360–1366
Miller KA, Pump A (2007) Use of bioabsorbable staple reinforcement material in gastric bypass: a prospective randomized clinical trial. Surg Obes Relat Dis 3:417–422
Shikora SA, Kim JJ, Tarnoff ME (2008) Comparison of permanent and nonpermanent staple line buttressing materials for linear gastric staple lines during laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 4:729–734
Angrisani L, Lorenzo M, Borrelli V, Ciannella M, Bassi UA, Scarano P (2004) The use of bovine pericardial strips on linear stapler to reduce extraluminal bleeding during laparoscopic gastric bypass: prospective randomized clinical trial. Obes Surg 14:1198–1202
Pinheiro JS, Correa JL, Cohen RV, Novaes JA, Schiavon CA (2006) Staple line reinforcement with new biomaterial increased burst strength pressure: an animal study. Surg Obes Relat Dis 2:397–399
Downey DM, Harre JG, Dolan JP (2005) Increased burst pressure in gastrointestinal staple-lines using reinforcement with a bioprosthetic material. Obes Surg 15:1379–1383
Chen B, Kiriakopoulos A, Tsakayannis D, Wachtel MS, Linos D, Frezza EE (2009) Reinforcement does not necessarily reduce the rate of staple line leaks after sleeve gastrectomy. A review of the literature and clinical experiences. Obes Surg 19:166–172
Baker RS, Foote J, Kemmeter P, Brady R, Vroegop T, Serveld M (2004) The science of stapling and leaks. Obes Surg 14:1290–1298
Consten EC, Gagner M (2004) Staple-line reinforcement techniques with different buttressing materials used for laparoscopic gastrointestinal surgery: a new strategy to diminish perioperative complications. Surg Technol Int 13:59–63
Kasalicky M, Michalsky D, Housova J (2008) Laparoscopic sleeve gastrectomy without over-sewing of the staple line. Obes Surg 18:1257–1262
Shikora SA (2004) The use of staple-line reinforcement during laparoscopic gastric bypass. Obes Surg 14:1313–1320
Lee MG, Provost DA, Jones DB (2004) Use of fibrin sealant in laparoscopic gastric bypass for morbid obesity. Obes Surg 14:1321–1326
Assalia A, Ueda K, Matteotti R, Cuenca-Abente F, Rogula T, Gagner M (2007) Staple-line reinforcement with bovine pericardium in laparoscopic sleeve gastrectomy: experimental comparative study in pigs. Obes Surg 17:222–228
Givon-Madhala O, Spector R, Wasserberg N, Beglaibter N, Lustigman H, Stein M, Arar N, Rubin M (2007) Technical aspects of laparoscopic sleeve gastrectomy in 25 morbidly obese patients. Obes Surg 17:722–727
Bernante P, Foletto M, Busetto L, Pomerri F, Pesenti FF, Pelizzo MR, Nitti D (2006) Feasibility of laparoscopic sleeve gastrectomy as a revision procedure for prior laparoscopic gastric banding. Obes Surg 16:1327–1330
Liu CD, Glantz GJ, Livingston EH (2003) Fibrin glue as a sealant for high-risk anastomosis in surgery for morbid obesity. Obes Surg 13:45–48
Cooper JD (1994) Technique to reduce air leaks after resection of emphysematous lung. Ann Thorac Surg 57:1038–1039
Nguyen NT, Longoria M, Chalifoux S, Wilson SE (2005) Bioabsorbable staple line reinforcement for laparoscopic gastrointestinal surgery. Surg Technol Int 14:107–111
Franklin ME Jr, Ramila GP, Treviño JM, Gonzalez JJ, Russek K, Glass JL, Kim G (2006) The use of bioabsorbable staple line reinforcement for circular stapler (BSG “SeamGuard”) in colorectal surgery: initial experience. Surg Laparosc Endosc Percutan Tech 16:411–415
Tucker JG, Copher JC, Reilly JP, Fitzsimmons TR (2007) The use of bioabsorbable seamguard during laparoscopic appendectomy. Surg Laparosc Endosc Percutan Tech 17:83–85
de la Portilla F, Zbar AP, Rada R, Vega J, Cisneros N, Maldonado VH, Utrera A, Espinosa E (2006) Bioabsorbable staple-line reinforcement to reduce staple-line bleeding in the transection of mesenteric vessels during laparoscopic colorectal resection: a pilot study. Tech Coloproctol 10:335–338
Franklin ME Jr, Berghoff KE, Arellano PP, Trevino JM, Abrego-Medina D (2005) Safety and efficacy of the use of bioabsorbable seamguard in colorectal surgery at the Texas Endosurgery Institute. Surg Laparosc Endosc Percutan Tech 15:9–13
Consten EC, Dakin GF, Gagner M (2004) Intraluminal migration of bovine pericardial strips used to reinforce the gastric staple-line in laparoscopic bariatric surgery. Obes Surg 14:549–554
Ser KH, Lee WJ, Lee YC, Chen JC, Su YH, Chen SC (2010) Experience in laparoscopic sleeve gastrectomy for morbidly obese Taiwanese: staple-line reinforcement is important for preventing leakage. Surg Endosc 24:2253–2259
Dapri G, Cadiere GB, Himpens J (2010) Reinforcing the staple line during laparoscopic sleeve gastrectomy: prospective randomized clinical study comparing three different techniques. Obes Surg 20:462–467
Silecchia G, Boru CE, Mouiel J, Rossi M, Anselmino M, Morino M, Toppino M, Gaspari A, Gentileschi P, Tacchino R, Basso N (2008) The use of fibrin sealant to prevent major complications following laparoscopic gastric bypass: results of a multicenter, randomized trial. Surg Endosc 22(11):2492–2497 Epub 2008 Mar 26
Silecchia G, Boru CE, Mouiel J, Rossi M, Anselmino M, Tacchino RM, Foco M, Gaspari AL, Gentileschi P, Morino M, Toppino M, Basso N (2006) Clinical evaluation of fibrin glue in the prevention of anastomotic leak and internal hernia after laparoscopic gastric bypass: preliminary results of a prospective, randomized multicenter trial. Obes Surg 16(2):125–131
Efthimiou E, Al-Sabah S, Sampalis JS, Christou NV (2010) Fibrin sealant associated with increased body temperature and leukocytosis after laparoscopic gastric bypass. Surg Obes Relat Dis 6(1):46–49 Epub 2009 Mar 17
Giannopoulos GA, Tzanakis NE, Rallis GE, Efstathiou SP, Tsigris C, Nikiteas NI (2010) Staple line reinforcement in laparoscopic bariatric surgery: does it actually make a difference? A systematic review and meta-analysis. Surg Endosc 24(11):2782–2788 Epub 2010 Apr 16
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Paolo Gentileschi, Ida Camperchioli, Stefano D’Ugo, Domenico Benavoli, and Achille L. Gaspari have no conflict of interest or financial ties to disclose.
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Gentileschi, P., Camperchioli, I., D’Ugo, S. et al. Staple-line reinforcement during laparoscopic sleeve gastrectomy using three different techniques: a randomized trial. Surg Endosc 26, 2623–2629 (2012). https://doi.org/10.1007/s00464-012-2243-2
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DOI: https://doi.org/10.1007/s00464-012-2243-2