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Prospective comparative study of the efficacy of staple-line reinforcement in laparoscopic sleeve gastrectomy

Abstract

Background

Staple-line reinforcement has been used with promising results in laparoscopic gastric bypass in order to reduce leakage, increase staple-line integrity, and diminish staple-site bleeding. The purpose of this study was to determine if staple-line reinforcement with bovine pericardial strips reduces surgical complications of laparoscopic sleeve gastrectomy (LSG).

Methods

This is a prospective comparative study of all patients who underwent LSG by a standard operative team in an 18-month period. Patients were enrolled in group A if they received staple-line reinforcement and in group B when not. The staple line was reinforced with bovine pericardium strips [Peri-Strips Dry® (PSD)].

Results

In total, 187 patients, with a median preoperative BMI of 45.3 kg/m2 (range = 35.1–72.7), underwent LSG. Ninety-six patients were enrolled in group A and 91 in group B; the two groups were comparable in their various characteristics. Morbidity rate representing grade III–IV surgical complications reached 7.4% and mortality rate was 0.5%. Reinforcement with PSD significantly reduced the occurrence of bleeding from the staple line and intra-abdominal collections (P = 0.012 and 0.026). The leak rate was not significantly reduced in group A. Patients in group A required fewer days of hospitalization.

Conclusions

Reinforcement of the staple line in LSG resulted in significantly fewer surgical complications compared to standard stapling of the gastric tube. The additional cost due to the reinforcement of the staple line may be counterbalanced by the reduction in the length of hospitalization.

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References

  1. 1.

    Brown S, Woo E (2004) Surgical stapler-associated fatalities and adverse events reported to the food and drug administration. J Am Col Surg 199:374–381

  2. 2.

    Nguyen NT, Longoria M, Welbourne S, Sabio A, Wilson SE (2005) Glycolide copolymer staple-line reinforcement reduces staple site bleeding during laparoscopic gastric bypass. Arch Surg 140:773–778

  3. 3.

    Mongol P, Chosidow D, Marmuse JP (2006) Laparoscopic sleeve gastrectomy (LSG): review of a new bariatric procedure and initial results. Surg Technol Int 15:47–52

  4. 4.

    Tucker ON, Szomstein S, Rosenthal RJ (2008) Indications for sleeve gastrectomy as a primary procedure for weight loss in the morbidly obese. J Gastrointest Surg 12:662–667

  5. 5.

    Shikora SA, Κim JJ, Τarnoff ΜΕ (2003) Reinforcing gastic staple-line with bovine pericardial strips may decrease the likelihood of gastric leak after laparoscopic Roux-en-Y bypass. Obes Surg 13:37–44

  6. 6.

    Wassner JD, Yohai E, Heimlich H (1977) Complications associated with the use of gastrointestinal stapling devices. Surgery 82:393–399

  7. 7.

    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

  8. 8.

    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: a prospective randomized clinical trial. Obes Surg 17:1379–1383

  9. 9.

    Baker RS, Foote J, Kemmeter P, Brady R, Vroegop T, Serveld M (2004) The science of stapling and leaks. Obes Surg 14:1360–1366

  10. 10.

    Baker RS, Foote J, Kemmeter P, Brady R, Vroegop T, Serveld M (2003) A comparison of staple leaks with cartridge selection, oversewing and buttressing. Obes Surg 13:487–583

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Disclosure

Drs. Konstantinos M. Stamou, Evangelos Menenakos, Dimitris Dardamanis, Calliope Arabatzi, Leonidas Alevizos Konstantinos Albanopoulos, Emmanuel Leandros, and George Zografos have no conflicts of interest or financial ties to disclose.

Author information

Correspondence to Konstantinos M. Stamou.

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Stamou, K.M., Menenakos, E., Dardamanis, D. et al. Prospective comparative study of the efficacy of staple-line reinforcement in laparoscopic sleeve gastrectomy. Surg Endosc 25, 3526–3530 (2011). https://doi.org/10.1007/s00464-011-1752-8

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Keywords

  • LSG
  • Staple-line reinforcement
  • Complications