Staple Line Bleeding in Sleeve Gastrectomy-a Simple and Cost-Effective Solution

Area of Science:

• Bariatric Surgery
• Surgical Complications
• Hemostasis

Background:

• Staple line bleeding (SLB) is a frequent intraoperative complication in laparoscopic sleeve gastrectomy (SG).
• Current management strategies for SLB, including reinforcement, suturing, and diathermy, have varying efficacy and cost implications.
• Tranexemic acid, an antifibrinolytic agent, is recognized for its hemostatic properties in other surgical contexts.

Purpose of the Study:

• To evaluate the efficacy of intraoperative tranexemic acid in reducing staple line bleeding during laparoscopic sleeve gastrectomy.
• To compare the number of bleeding points requiring intervention between patients receiving tranexemic acid and a control group.

Main Methods:

• A prospective matched comparative study involving laparoscopic sleeve gastrectomy patients.
• One cohort received tranexemic acid (1g) intraoperatively, while the control group did not.
• Primary outcome: number of staple line bleeding points requiring intervention; secondary outcomes: estimated blood loss and operating time.

Main Results:

• The tranexemic acid group required significantly fewer haemostatic stitches for staple line bleeding (19 vs. 46, p < 0.05).
• Intraoperative blood loss was significantly reduced in the treatment group (p < 0.01).
• Operating times were significantly shorter in patients receiving tranexemic acid (median 66 vs. 80 min, p < 0.05).

Conclusions:

• Intraoperative prophylactic tranexemic acid is a simple, economical, and effective method for reducing staple line bleeding in SG.
• The use of tranexemic acid leads to a significant decrease in operative time.
• No differences in morbidity or mortality were observed between the groups.