Does Stapling Platform Influence Robotic Sleeve Gastrectomy Postoperative Outcomes?

Laparoscopic sleeve gastrectomy (LSG) accounts for the majority of weight loss surgeries worldwide. Although the overall side effect profile is low, the rate of de novo gastroesophageal reflux disease (GERD) ranges between 2.1 and 49%. Our study compares postoperative outcomes using a single-fire stapler versus a multiple-fire linear stapler, with a focus on postoperative de novo GERD.

This was a retrospective single-surgeon study with data from 257 patients who underwent consecutive robotic-assisted sleeve gastrectomy between 2016 and 2023 with either multiple fires of a linear stapler (n = 201) or a single-fire linear stapler (n = 56). Patient demographics and postoperative outcomes, including 30-day complications, 1-year weight loss, and 1-year postoperative reflux, were analyzed.

Patients in the single-fire group were noted to have a significantly lower rate of postoperative reflux (7.1% vs. 26.4%) and a decreased incidence of de novo reflux (1.8% vs. 10.9%). Additionally, the single-fire group had a shorter average length of stay (2.0 days vs. 2.2 days, p = 0.04). Multivariable analysis demonstrated that single-fire stapler use increased the likelihood of not developing postoperative GERD (odds ratio: 8.4, 95% confidence interval: 2.8-32.5). There was no significant difference in operative time (multiple-fire group: 81.4 min, single-fire group: 90.1 min, p = 0.5) or 1-year percent total weight loss (multiple-fire: 22.4% ± 0.7%, single-fire: 22.0% ± 1.7%, p = 0.8).

Single-fire stapler use may enhance postoperative outcomes in LSG by reducing rates of de novo GERD without impacting weight loss. There was no significant difference in operative time, and postoperative length of stay may be decreased.