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Surgical Endoscopy
Published in: Surgical Endoscopy 9/2012

01-09-2012

Staple-line reinforcement during laparoscopic sleeve gastrectomy using three different techniques: a randomized trial

Authors: Paolo Gentileschi, Ida Camperchioli, Stefano D’Ugo, Domenico Benavoli, Achille L. Gaspari

Published in: Surgical Endoscopy | Issue 9/2012

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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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Metadata
Title
Staple-line reinforcement during laparoscopic sleeve gastrectomy using three different techniques: a randomized trial
Authors
Paolo Gentileschi
Ida Camperchioli
Stefano D’Ugo
Domenico Benavoli
Achille L. Gaspari
Publication date
01-09-2012
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 9/2012
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-012-2243-2

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