Role of Staple Line Reinforcement by Oversewing in Preventing Leakage and Bleeding after Sleeve Gastrectomy

Abstract

BACKGROUND: Staple line (SL) bleeding and leakage after laparoscopic sleeve gastrectomy (LSG) are still commonly challenging complications. Some surgeons use SL reinforcement (SLR) to decrease the rate of bleeding and leakage, by different methods such as oversewing, fibrin glue, and bovine pericardium, but their role in preventing complications is still controversial. AIM: The aim of this study is to evaluate the incidence of SL bleeding and leakage after LSG by oversewing SL using V-Loc suture material. METHODS: This is a retrospective study carried out on 200 consecutive patients with (body mass index [BMI] >40 kg/m2) or (>35 kg/m2 plus comorbid diseases associated with obesity), divided into two groups according to SLR. Study participants were divided into two equal groups, each one included 100 patients; Group A underwent LSG without SLR, and Group B underwent LSG with SLR. RESULTS: Post-operative SL bleeding was 4% in Group A and 2% in Group B (p = 0.315). Bleeding control by reoperation was 4% in Group A and 0% in Group B (p = 0.021). Just two patients had leakage in Group A (2%) and were managed with endoscopic stenting (p = 0.105). Operative time was shorter in Group A than in Group B, with a mean of 80 and 91.41 min, respectively (p < 0.001). CONCLUSION: SLR with V-Loc suture was not effective in reducing the incidence of post-operative bleeding or leakage. However, it has a positive effect on reducing the incidence of reoperation, despite the prolongation of operative time. There is a need for more studies including larger samples to investigate the effectiveness in reducing the post-operative complications of sleeve gastrectomy operation; therefore, more prospective studies on a wide population are advised to ensure the effectiveness of reinforcement of stale line in the prevention of sleeve gastrectomy complications.