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

Area of Science:

• Bariatric Surgery
• Minimally Invasive Procedures
• Surgical Complication Reduction

Background:

• Laparoscopic sleeve gastrectomy (LSG) is associated with significant postoperative complications.
• Staple line reinforcement (SLR) is crucial for mitigating these risks.
• Evaluating different SLR techniques is essential for improving patient outcomes.

Purpose of the Study:

• To prospectively compare three distinct staple line reinforcement (SLR) techniques during laparoscopic sleeve gastrectomy (LSG).
• To assess operative time, staple-line bleeding, and leaks for each SLR method.

Main Methods:

• A prospective randomized study involving 120 patients undergoing LSG.
• Three groups received different SLR: oversewing (A), buttressed transection with polyglycolide acid/trimethylene carbonate (B), and staple-line roofing with gelatin fibrin matrix (C).
• Operative time for SLR and incidence of postoperative bleeding and leaks were primary endpoints.

Main Results:

• Mean SLR operative time was significantly longer for oversewing (14.2 min) compared to polyglycolide acid/trimethylene carbonate (2.4 min) and gelatin fibrin matrix (4.4 min) (P < 0.01).
• Overall complication rates were similar across groups (3.3%), with one leak and one bleed in group A, one bleed in group B, and one leak in group C.
• No mortality was observed in any group.

Conclusions:

• Staple line reinforcement (SLR) using polyglycolide acid with trimethylene carbonate or gelatin fibrin matrix is significantly faster than oversewing during LSG.
• No significant differences in postoperative staple-line complications were found between the evaluated SLR techniques.