Tranexamic Acid Administration in Laparoscopic Sleeve Gastrectomy

Perioperative bleeding remains one of the most frequent early complications of laparoscopic sleeve gastrectomy (LSG). The present work aimed to provide a thorough and updated systematic review and meta-analysis of the published studies on the use of tranexamic acid (TXA) in LSG.

The present study was conducted according to the Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) guidelines. A systematic literature search was conducted in PubMed, Scopus, and Web of Science.

The present study analyzed 9 studies. They included 1665 patients. TXA was administered to 842 patients while 823 patients received no intervention or placebo. Pooled analysis revealed significantly shorter operative duration [mean difference (95% CI): -4.56 (-7.36, -1.76), p = 0.001], shorter length of hospital stay [mean difference (95% CI): -0.12 (-0.16, -0.08), p<0.00001] and lower reduction of preoperative hemoglobin levels in the TXA arm [mean difference (95% CI): -0.2 (-0.38, -0.02), p = 0.03]. No significant differences were found between the interventional arms regarding number of used intraoperative hemostatic clips [mean difference (95% CI): -0.2 (-0.93, 0.53), p = 0.59], number of patients requiring blood transfusion [RD (95% CI): -0.01 (-0.02, 0.0), p = 0.08] or number of patients requiring reoperation for bleeding [RD (95% CI): -0.01 (-0.03, 0.0), p = 0.12]. No thromboembolic events were reported.

The present study suggests that, based on the currently available evidence, intraoperative administration of TXA is associated with lower reduction of preoperative hemoglobin levels in patients undergoing LSG, which may contribute to shorter operative duration and reduced length of hospital stay.