Laparoscopic Sleeve Gastrectomy: Suture or not Suture Staple Line

Authors

  • Sabah Kareem Al hussaini General Consultant Surgeon, College of Medicine, University of Karbala, Iraq Author
  • Marwa Issa Yaseen General Surgeon - Karbala Health Director, Al Hussaini Medical City Author

DOI:

https://doi.org/10.59675/M212

Keywords:

Laparoscopic sleeve gastrectomy (LSG), Staple line reinforcement (SLR)

Abstract

Background The severity of postoperative complications is the main disadvantage of laparoscopic sleeve gastrectomy (LSG). Staple line reinforcement (SLR) is strongly advocated. Recently, oversewing has been proposed as a cost-effective and helpful method for reinforcing the staple line. Aim of the study: To evaluate the benefit of staple lines over sewing in decreasing postoperative complications and their severity.

Patients and methods: One hundred laparoscopic surgery group (LSG) patients were randomly assigned to either group (A) without staple line over sewing or (B) with staple line over sewing from January 2022 to January 2023 in a prospective study conducted at three hospitals (Alhussein Medical City, Alkafeel Private Hospital, and Zain Alabdin Private Hospital). We want to learn if laparoscopic sleeve gastrectomy patients benefited more from a staple line than a sewn one. Results: The most frequently reported complication was bleeding, which was reported in two patients in group A and one patient in group B, respectively; vomiting was reported more frequently in group B. The cross-tabulation between complications and comorbidities revealed no significant association between them. The hospital stay was the same in both groups except for patients with non-surgical complications, which need more hospital stay time. In regard to the severity of complications, we found that complicated cases in group A needed more hospital stays and more interventions to control the problem in comparison to those in group B.

Conclusion: Laparoscopic sleeve gastrectomy with staple line over sewing is a technique that may decrease early complications and the severity of complications. There was no significant difference between the two groups (with and without staple line over sewing) in regard to the relation between complications on one side and the comorbidity on the other.

References

Di Cesare, M., Bentham, J., Stevens, G. A., Zhou, B., Danaei, G., Lu, Y., ... & Damasceno, A. (2016). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet, 387(10026)

Ng, M., Fleming, T., Robinson, M., Thomson, B., Graetz, N., Margono, C., ... & Gakidou, E. (2014). Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. The lancet, 384(9945), 766-781.

World Health Organization. (2020). WHO guideline on use of ferritin concentrations to assess iron status in populations. World Health Organization.

Franco, Juan Victor A., et al. "A review of studies comparing three laparoscopic procedures in bariatric surgery: sleeve gastrectomy, Rouxen-Y gastric bypass and adjustable gastric banding." Obesity surgery 21 (2011): 1458-1468

5.Alex, A. A., Chendamarai, E., Ganesan, S., Balasundaram, N., Palani, H. K., David, S., & Mathews, V. (2014). Arsenic trioxide resistance: more to it than mutations in PML-RARα. Blood, 124(21), 3605.

Siddiq, G., Aziz, W., Pervez, M. B., Haider, M. I., Hussain, S. V., & Khan, N. (2016). Early laparoscopic sleeve gastrectomy outcomes in terms of weight loss. J Coll Physicians Surg Pak, 26(3), 169-172.

Fischer, L., Wekerle, A. L., Bruckner, T., Wegener, I., Diener, M. K., Frankenberg, M. V., ... & Müller-Stich, B. P. (2015). BariSurg trial: Sleeve gastrectomy versus Roux-en-Y gastric bypass in obese patients with BMI 35–60 kg/m2–a multi-centre randomized patient and observer blind non-inferiority trial. BMC surgery, 15(1), 1-8.

Ikramuddin, S., Korner, J., Lee, W. J., Connett, J. E., Inabnet, W. B., Billington, C. J., ... & Bantle, J. P. (2013). Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. Jama, 309(21), 2240-2249.

Parikh, M., Issa, R., McCrillis, A., Saunders, J. K., UdeWelcome, A., & Gagner, M. (2013). Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Annals of surgery, 257(2), 231-237

Frezza, Eldo E., Maurizio Chiriva-Internati, and Mitchell S. Wachtel. "Analysis of the results of sleeve gastrectomy for morbid obesity and the role of ghrelin." Surgery today 38 (2008): 481-483.

Gagner, Michel, et al. "The second international consensus summit for sleeve gastrectomy, March 19–21, 2009." Surgery for obesity and related diseases 5.4 (2009): 476-485.

Gumbs, A. A., Gagner, M., Dakin, G., & Pomp, A. (2007). Sleeve gastrectomy for morbid obesity. Obesity surgery, 17, 962-969

Crookes, P. "Management of severe reflux after sleeve gastrectomy." Abstract of Second International Consensus Summit for Sleeve Gastrectomy, Miami Beach, FL (2009).

Dapri, Giovanni, Guy Bernard Cadière, and Jacques Himpens. "Laparoscopic seromyotomy for long stenosis after sleeve gastrectomy with or without duodenal switch." Obesity surgery 19 (2009): 495-499.

Langer, F. B., Bohdjalian, A., Felberbauer, F. X., Fleischmann, E., Reza Hoda, M. A., Ludvik, B., ... & Prager, G. (2006). Does gastric dilatation limit the success of sleeve gastrectomy as a sole operation for morbid obesity?. Obesity surgery, 16(2), 166-171.

Brethauer, Stacy A., Jeffrey P. Hammel, and Philip R. Schauer. "Systematic review of sleeve gastrectomy as staging and primary bariatric procedure." Surgery for obesity and related diseases 5.4 (2009): 469-475.

Serra, C., Baltasar, A., Andreo, L., Pérez, N., Bou, R., Bengochea, M., & Chisbert, J. J. (2007). Treatment of gastric leaks with coated selfexpanding stents after sleeve gastrectomy. Obesity surgery, 17, 866-872.

Casella, G., Soricelli, E., Rizzello, M., Trentino, P., Fiocca, F., Fantini, A., ... & Basso, N. (2009). Nonsurgical treatment of staple line leaks after laparoscopic sleeve gastrectomy. Obesity surgery, 19, 821-826. of the American, Clinical Issues Committee.

"American Society for Metabolic and Bariatric Surgery position statement on emergency care of patients with complications related to bariatric surgery." Surgery for Obesity and Related Diseases 6.2 (2010): 115-117.

Baltasar, A., Bou, R., Bengochea, M., Serra, C., & Cipagauta, L. (2007). Use of a Roux limb to correct esophagogastric junction fistulas after sleeve gastrectomy. Obesity Surgery, 17(10), 1408.

Peterli, R., Wölnerhanssen, B. K., Peters, T., Vetter, D., Kröll, D., Borbély, Y., ... & Bueter, M. (2018). Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. Jama, 319(3), 255-265.

Spaniolas, K., Kasten, K. R., Brinkley, J., Sippey, M. E., Mozer, A., Chapman, W. H., & Pories, W. J. (2015). The changing bariatric surgery landscape in the USA. Obesity surgery, 25, 1544-1546.

Rosenthal, Raul J., and International Sleeve Gastrectomy Expert Panel. "International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of> 12,000 cases." Surgery for Obesity and Related Diseases 8.1 (2012): 8-19.

Aurora, Alexander R., Leena Khaitan, and Alan A. Saber. "Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients." Surgical endoscopy 26 (2012): 1509-1515.

Shah, Shashank S., Jayashree S. Todkar, and Poonam S. Shah. "Erratum to: Buttressing the Staple Line: A Randomized Comparison Between Staple-Line Reinforcement Versus No Reinforcement During Sleeve Gastrectomy." Obesity Surgery 25.2 (2015): 392.

Albert, Matthew, Constantine Spanos, and Scott Shikora. "Morbid obesity: the value of surgical intervention." Clinics in Family Practice 4.2 (2002): 447-468.

Buchwald, Henry, and Danette M. Oien. "Metabolic/bariatric surgery worldwide 2011." Obesity surgery 23 (2013): 427-436.

Shikora, Scott A., and Christine B. Mahoney. "Clinical benefit of gastric staple line reinforcement (SLR) in gastrointestinal surgery: a meta-analysis." Obesity surgery 25 (2015): 1133-1141.

Baker, R. S., Foote, J., Kemmeter, P., Brady, R., Vroegop, T., & Serveld, M. (2004). The science of stapling and leaks. Obesity surgery, 14(10), 1290-1298.

Downey, Douglas M., Joseph G. Harre, and James P. Dolan. "Increased burst pressure in gastrointestinal staple-lines using reinforcement with a bioprosthetic material." Obesity surgery 15.10 (2005): 1379-1383.

Arnold, William, and Scott A. Shikora. "A comparison of burst pressure between buttressed versus non-buttressed staple-lines in an animal model." Obesity surgery 15.2 (2005): 164-171.

Knapps, J., Ghanem, M., Clements, J., & Merchant, A. M. (2013). A systematic review of staple-line reinforcement in laparoscopic sleeve gastrectomy. JSLS: Journal of the Society of Laparoendoscopic Surgeons, 17(3), 390.

Dapri, Giovanni, Guy Bernard Cadière, and Jacques Himpens. "Reinforcing the staple line during laparoscopic sleeve gastrectomy: prospective randomized clinical study comparing three different techniques." Obesity surgery 20 (2010): 462-467

Rogula, T., Khorgami, Z., Bazan, M., Mamolea, C., Acquafresca, P., El-Shazly, O., ... & Schauer, P. (2015). Comparison of reinforcement techniques using suture on staple-line in sleeve gastrectomy. Obesity surgery, 25, 2219-2224.

Kasalicky, M., Michalsky, D., Housova, J., Haluzik, M., Housa, D., Haluzikova, D., & Fried, M. (2008). Laparoscopic sleeve gastrectomy without an over-sewing of the staple line. Obesity surgery, 18, 1257-1262.

Published

31-05-2024

Issue

Section

Articles

How to Cite

Sabah Kareem Al hussaini, & Marwa Issa Yaseen. (2024). Laparoscopic Sleeve Gastrectomy: Suture or not Suture Staple Line. Academic International Journal of Medical Sciences , 2(1), 24-34. https://doi.org/10.59675/M212