Compression pre-stapler firing and post-ignition wait during sleeve gastrectomy: a prospective randomized trial

Abstract

INTRODUCTIONLaparoscopic sleeve gastrectomy (LSG) is the preferred surgical option to address obesity and is the most widely used procedure. 1 LSG offers several advantages including ease of learning compared to other procedures, short operation time, and minimal changes to the natural anatomy of the gastrointestinal system. Additionally, the surgical outcomes had positive effects on weight loss and comorbidities. However, despite technological advancements, the complication rate for leakage and bleeding remained between 0.5% and 2%. 2 In 90% of cases, leaks occur at the sense angle, and they are likely related to technical errors during stapler firing. 3 Techniques that strengthen the staple line to reduce complications place an economic burden on payment systems by increasing patient costs. Staple malformation is the main cause of leakage and bleeding. 4,5 OBJECTIVEThis study aimed to examine the potential effectiveness of precompression of 30 s before stapler firing and a waiting period of 30 s after firing, without utilizing any additional support or reinforcement for the staple line, in minimizing both intraoperative and postoperative complications. We hypothesized that the waiting period would result in optimal B formation, thereby reducing bleeding and leakage. Identifying factors such as staple size during LSG and firing technique can assist in improving patient care and optimizing bariatric center outcomes by predicting complications. METHODS Study designA double-blind (patient, postoperative data collector, and statistician), randomized controlled prospective study on class III morbidly obese patients matched for body mass index (BMI)