Role of reinforcement of staple line in laparoscopic sleeve gastrectomy for patients with morbid obesity

Background
Postoperative staple line bleeding and leakage after laparoscopic sleeve gastrectomy (LSG) still pose potential challenging complications. Some studies have indicated staple line reinforcement (SLR) to decrease the rate of bleeding and leakage, but its efficacy is still being debated. The aim in this study was to evaluate the incidence of staple line bleeding and leakage during LSG after SLR using absorbable suture material.
Patients and methods
This was a retrospective study that included 180 consecutive patients who underwent LSG between January 2017 and October 2019 and were divided into two groups: 50 patients in group A (without SLR) and 130 patients in group B (with SLR). The study was conducted in Helwan University hospital and Dar Elshefa and El Merghany private hospitals.
Results
Postoperative staple line bleeding was 4% in group A compared with 1.5% in group B (=0.315). Bleeding control by reoperation was 4 and 0% in groups A and B, respectively (=0.021). Just one patient had leakage in group A (2%) and was managed with endoscopic clipping and stenting (=0.105). Operative time was shorter in group A than in group B, with mean of 70 and 81.41 min, respectively (<0.001).
Conclusion
SLR by oversewing using absorbable suture material during LSG is safe and efficient in reducing the incidence of reoperation to control postoperative staple line bleeding despite the fact that it significantly increased the operative time. Nonetheless, more studies are needed on a larger number of patients with various reinforcement techniques to prove its effectiveness. SLR with absorbable suture material is safe and efficient in LSG and may reduce the need for reoperation despite prolonging the operating time and not being statistically significant in reducing the incidence of complications such as bleeding or leakage.