The Effect of Reinforcement Methods with Knotted and Knotless Sutures: Comparison of Burst Pressures

Sleeve gastrectomy operations have become popular among restrictive obesity surgeons, due to its effectiveness for losing weight and acceptable complication rates. However, leakage is a significant problem in these operations. In this ex vivo study, we tried to understand mechanisms of leakage and to examine the effects of two different types of frequently referred reinforcement techniques using sutures. The resected gastric specimens that were removed during sleeve gastrectomy operations were used in this ex vivo study. Foley catheters were inserted to stomach from two different areas along the greater curvature of stomach, and one of these catheters was connected to monitoring apparatus with intra-abdominal pressure measurement system. The other Foley catheter was connected to syringe apparatus with 1000 cc physiological saline. No reinforcement procedure was applied to staple line in the first group. In the second group, staple line was sutured continuously with 2/0 knotless absorbable suturing material. In the third group, continuous suturing was applied using 2/0 knotted absorbable sutures. Next, stomach was filled with physiological saline, and the site of leak and the pressure value at the level of leakage were noted. Pressure values that caused leakage in no reinforcement suture, knotless suture, and knotted suture groups were 42.7 (±1), 98.7 (± 3.9), and 97.7 (±4.1) mmHg, respectively. The pressure difference between the groups was statistically significant (P = .000). As for the site of leaks, 26 (58%) were in corpus, 14 (31%) were in antrum, and 5 (11%) were in fundus, and there was no significant difference between the groups in terms of leakage sites (P = .97). In sleeve gastrectomy operations, reinforcement of staple line using either knotless or knotted sutures may help to prevent leakage.