Comparing Reinforcement Options for the Staple Line of Laparoscopic Sleeve Gastrectomy.

Bayrak, Mehmet; Altintas, Yasemin

OBJECTIVE To compare three reinforcement options (suture, fibrin glue, and no reinforcement) for staple line reinforcement of patients undergoing laparoscopic sleeve gastrectomy. STUDY DESIGN An experimental study. PLACE AND DURATION OF STUDY Ortadogu Hospital, Adana, Turkey, from 2013 to 2017. METHODOLOGY The inclusion criteria were patients with BMI > 40 Kg/m² or >35 Kg/m² (if there were comorbid diseases associated with obesity). The exclusion criteria were patients who were older than 65 years or had a bariatric procedure earlier. The patients were placed in three groups. Group 1 had no staple line reinforcement, group 2 had fibrin glue on the staple line, and group 3 had barbed continued suture on the staple line. The primary endpoints included stenosis, bleeding, and postoperative leaks. The secondary outcomes included total operation time and time for staple line reinforcement. Values of p<0.05 were deemed significant for all statistical tests. RESULTS The mean time to perform the staple line reinforcement was significantly higher in group 3 (22.05 ± 2.83 minutes) than in group 2 (fibrin glue, 10.86 ± 2.15 minutes, p<0.001). The mean total operation times were significantly different between all three groups; 70.8 ± 5.4 minutes for group 1, 74.7 ± 6.2 minutes for group 2, and 81.2 ± 3.0 minutes for group 3 (p<0.001). The groups had no statistical differences regarding complications. CONCLUSION The use of fibrin glue and barbed continuous suture for staple line reinforcement during laparoscopic sleeve gastrectomy had no effect on post- or per-operative hemorrhage and leakage; however, these procedures significantly extended the operation time.