Staple line oversewing during laparoscopic sleeve gastrectomy

Wang, H; Lu, Jie; Feng, Jiarong; Z, Wang

doi:10.1308/rcsann.2017.0074

Cited by 25 publications

(12 citation statements)

References 31 publications

(37 reference statements)

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“…Taha et al suggested that staple-line reinforcement by hand-sewing may require additional operating time and that average surgical time is significantly shorter in patients who underwent LSG without oversewing of the staple line. 22 This aspect is also highlighted in the meta-analysis of Wang et al 14 The shorter surgical time detected in our series may be due to the fact that the introduction of the reinforced lines occurred when the learning curve of the surgical team had already been completed, adding enough experience to be able to decrease surgical time. Studies by Aggrwal et al and Sroka et al suggest that the diminished bleeding rate after oversewn LSG may be attributed to the learning curve effect and not only the efficacy and effectiveness of the method of reinforcing the stapling line.…”

Section: Discussionsupporting

confidence: 55%

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Stapling technology with triple-row and enhanced staple configurations evaluated in a series of 124 consecutive laparoscopic vertical gastrectomies

et al. 2019

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Background: Laparoscopic sleeve gastrectomy (LSG) is a procedure frequently used to treat morbid obesity, due to its simplicity compared to other bariatric techniques. However, LSG can lead to serious complications, such as gastric leakage and bleeding from the staple line. To reduce these complications, seroserosal reinforcement of the mechanical suture line after gastrectomy is generally recommended. In recent decades, studies have focused on the safety of anastomosis with staples, especially compared to manual sewing techniques. Since studies on the improvement of stapling technology are limited, this study arises to compare the clinical results of staple line oversewing versus stapling technology with triple-row and enhanced staple configurations in laparoscopic sleeve gastrectomy.Methods: A retrospective review from a prospectively maintained database of 124 laparoscopic vertical gastrectomies performed at single centre between March 2010 and December 2016. Patients were divided into two groups, with comparable anthropometric parameters and inclusion criteria. Seroserosal reinforcement was used in the first group, and stapling technology with triple-row and enhanced staple configurations in the second. Rates of anastomotic leakage, bleeding, reoperation, and 30-day mortality were compared.Results: In Group 1 the average surgical time was 125 min, whereas in Group 2 it was 87 min. No differences were found between the two groups regarding leakage or bleeding of the staple line.Conclusions: The use of triple-row stapling devices during laparoscopic vertical gastrectomy enables surgical time to be reduced. Further high-quality studies to evaluate the efficacy and effectiveness of stapling technology with triple-row and enhanced staple configurations are needed.

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Section: Discussionsupporting

confidence: 55%

“…13 Despite this, some worrisome complications associated with LSG have been described. 14 15 These complications can range from minor sequelae to extremely serious, life-threatening events. It has been described that the reduction of postoperative bleeding and leakage could prevent serious events such as peritonitis and septic shock.…”

Section: Discussionmentioning

confidence: 99%

Stapling technology with triple-row and enhanced staple configurations evaluated in a series of 124 consecutive laparoscopic vertical gastrectomies

et al. 2019

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“…11 A large meta-analysis of 7 randomized controlled trials found no significant difference in bleeding when performing staple line oversewing during LSG. 12 Most of the studies showing no benefit for staple line treatment have smaller sample sizes and may be lacking in power to demonstrate a difference.…”

Section: Discussionmentioning

confidence: 99%

Staple Line Treatment and Bleeding After Laparoscopic Sleeve Gastrectomy

Zafar

Felton

Miller

et al. 2018

JSLS

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Background and Objectives:Staple line treatment during laparoscopic sleeve gastrectomy (LSG) remains a controversial issue among bariatric surgeons. The objective of this study was to compare rates of postoperative bleeding (POB) among various methods of staple line reinforcement.Methods:The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program 2015 dataset was queried for patients undergoing an LSG. Patients were stratified by staple line treatment groups—no treatment (NT), suture oversewing (OVERSEW), buttressing by a commercial product (BUTTRESS), and both buttress and oversew (COMBINATION). The primary outcome was POB. Multivariable logistic regression was used to compare POB rates among the treatment groups.Results:In the 98,142 LSG patients meeting selection criteria, 623 (0.63%) patients had POB and 181 (0.18%) required reoperation. POB occurred in 0.80% for the NT group, 0.68% for the OVERSEW group, 0.57% for the BUTTRESS group, and 0.55% for the COMBINATION group. On multivariable analyses, all treatment groups were less likely to have POB compared with the NT group—OVERSEW (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.54–0.98), BUTTRESS (OR 0.70, 95% CI 0.57–0.84), and COMBINATION (OR 0.66, 95% CI 0.50–0.89) (all P < .01). Subset analysis revealed no difference between BUTTRESS and OVERSEW (OR 0.95, 95% CI 0.71–1.26, P = .71).Conclusions:Relative to an NT staple line, the use of OVERSEW or BUTTRESS can decrease the rates of POB by up to 30%. The use of these techniques should be strongly considered by the bariatric surgeon.

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“… 9 – 11 In addition, they are practiced variably among surgeons, increase the cost of surgery, and may instead diminish the integrity of the staple line. 12 – 14 …”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11] In addition, they are practiced variably among surgeons, increase the cost of surgery, and may instead diminish the integrity of the staple line. [12][13][14] The current variability of reinforcement outcomes warrants the need for a stapler that produces a drier staple line and can therefore reduce the need for staple line manipulation. There are currently two legacy brands in the endostapler market with well-established outcomes.…”

Section: Introductionmentioning

confidence: 99%

Improving Hemostasis in Sleeve Gastrectomy With Alternative Stapler

Redmann¹,

Lavin²,

French³

et al. 2020

JSLS

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Background: Staple line bleeding can be a major intraoperative complication during laparoscopic sleeve gastrectomy, requiring reinforcing interventions that may diminish the integrity of the staple line and put patients at risk for postoperative hemorrhage or leak. To improve outcomes associated with surgery, surgeons may benefit from an alternative stapler that produces a drier staple line and requires less staple line manipulation.Methods: Sixty consecutive laparoscopic sleeve gastrectomy procedures were performed by three surgeons; 30 sleeves using the AEON TM Endostapler on THICK MODE and 30 using the Echelon Flex TM Powered Stapler with pulse technique. Stapler performance was measured by incidence and degree of staple line bleeding. Images of the first firing and fundus were taken with the laparoscope 10 seconds after the final firing. Images were evaluated by a third-party blinded evaluator and given a "bleeding score," a qualitative measure of intra-operative staple-line bleeding (1 = no bleeding to 5 = profuse bleeding). Results:The AEON TM Endostapler demonstrated a lower mean (6 standard error) "bleeding score" versus the Echelon Flex TM (2.1 6 0.1 vs. 2.6 6 0.1; p = 0.01). The AEON TM Endostapler had 15 cases (50%) with no bleeding at the fundus; the Echelon Flex TM had 7 cases (23%) with no bleeding at the fundus. The AEON TM Endostapler had 0 cases (0%) with profuse bleeding; the Echelon Flex TM had 2 cases (7%) with profuse bleeding. Conclusion:The AEON TM Endostapler is a significantly drier alternative to the Echelon Flex TM Powered Stapler, producing a much drier staple line and decreasing the need for other bleeding control methods.

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Staple line oversewing during laparoscopic sleeve gastrectomy

Cited by 25 publications

References 31 publications

Stapling technology with triple-row and enhanced staple configurations evaluated in a series of 124 consecutive laparoscopic vertical gastrectomies

Stapling technology with triple-row and enhanced staple configurations evaluated in a series of 124 consecutive laparoscopic vertical gastrectomies

Staple Line Treatment and Bleeding After Laparoscopic Sleeve Gastrectomy

Improving Hemostasis in Sleeve Gastrectomy With Alternative Stapler

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