Clinical Benefit of Gastric Staple Line Reinforcement (SLR) in Gastrointestinal Surgery: a Meta-analysis

Abstract

BackgroundThe objective of this study was to assess whether the use of staple line reinforcement (SLR) reduces staple line complications (SLC). Mechanical staple lines are essential for gastrointestinal surgery such as bariatric surgery. However, SLC, such as bleeding and leakage, still occur. The purposes of this study were to provide quantitative evidence on the relative efficacy of gastric SLR and to compare the rates of effectiveness of three commonly used methods.MethodsA search of the medical literature in English language journals identified studies from Jan 1, 2000, to Dec 31, 2013, using the following reinforcement types: (1) no reinforcement, (2) oversewing, (3) a biocompatible glycolide copolymer, and (4) bovine pericardium after gastric bypasses and sleeve gastrectomies. Types of reinforcement were compared using a random-effects model.ResultsThis meta-analysis reviewed 16,967 articles, extracting data on 56,309 patients concerning leak and 41,864 patients concerning bleeding. Over 40 % of patients had no reinforcement, resulting in the highest leak rate (2.75 %) and bleed rate (3.45 %). Overall, reinforcing with bovine pericardium had the lowest leak (1.28 %) and bleed (1.23 %) rates. Suture oversewing was better than no reinforcement but not as effective as bovine pericardium for leak (2.45 %) and bleed (2.69 %) rates. Buttressing with a biocompatible glycolide copolymer resulted in the second highest leak rate (2.61 %) and a bleed rate of 2.48 % but had significantly lower bleed rates than no reinforcement.ConclusionsSLR provided superior results for patients compared to no reinforcement for reducing SLC. Buttressing with bovine pericardium resulted in the most favorable outcomes. The effectiveness of different methods used to reinforce the staple line in gastric surgery does not appear to be equal.

Comparison of economic and clinical outcomes between patients undergoing laparoscopic bariatric surgery with powered versus manual endoscopic surgical staplers

“…According to the 2012 International Sleeve Gastrectomy Expert Panel Consensus Statement, the use of staple line reinforcement, such as a buttress or over-sewing the staple line, is thought to reduce bleeding along the staple line [20][21][22][23] . However, staple line reinforcement has been shown to be associated with an increased risk of leaks in observational studies [21][22][23] .…”

“…According to the 2012 International Sleeve Gastrectomy Expert Panel Consensus Statement, the use of staple line reinforcement, such as a buttress or over-sewing the staple line, is thought to reduce bleeding along the staple line [20][21][22][23] . However, staple line reinforcement has been shown to be associated with an increased risk of leaks in observational studies [21][22][23] . Although the Premier Perspective Hospital Database does not contain information to support identification of over-sewing the staple line, buttress materials can be identified from hospital administrative records by searching for billing records of buttress materials.…”

Outcome of over-sewing reinforcement of gastric staple line during laparoscopic sleeve gastrectomy in morbid obese patients: single center experience

“…8,12 Despite the advances in technology of surgical stapling devices, the rates of bleeding and leakage range from 1-5%, and more than 3% of LSG patients require reoperation. 8,10 A large series has demonstrated that the most serious complications included staple line leaks (0-10%), staple line bleeding (0-10%), and surrounding organ injury (0-5%). 13 Many factors were responsible for these complications including local tissue ischemia, increased intra-gastric pressure and undue lateral traction during gastric resection.…”

“…Therefore, more extensive data are needed to clearly determine if staple line reinforcement is beneficial or not. 10 The aim of this study is to detect the outcome of staple line reinforcement in LSG done by suture over-sewing technique in comparison to non-reinforcement in prevention of stable line complications as bleeding and leakage.…”

Management of Acute Bleeding Post Laparoscopic Sleeve Gastrectomy

“…Intra-operative packing to help control bleeding and allow hemostasis. Packing can be done with inserting gauze to help to identify the bleeding source [20,21]. Suction and irrigation can also help us to identify the source of bleeding and allow for the application of a clip, cauterizing the bleeding points, or application of under-running sutures (Figure 2).…”