The staple line in sleeve gastrectomy

Česká verzia

Authors: P. Zonča ^1,2; P. Guňková ²; L. Martínek ² ; A. Foltýs ²; M. Bužga ³ ; Jacobi Ca ¹
Authors place of work: Zentrum für Viszeral und Minimal Invasive Chirurgie, Wesseling, Německo přednosta: Prof. Dr. med. C. A. Jacobi, PhD. ¹; Chirurgická klinika LF OU a FN Ostrava, přednosta: Doc. MUDr. P. Zonča, PhD., FRCS ²; Katedra fyziologie a patofyziologie, LF OU v Ostravě, vedoucí: Doc. RNDr. P. Švorc, CSc. ³
Published in the journal: Rozhl. Chir., 2013, roč. 92, č. 7, s. 373-378.
Category: Original articles

Summary

Introduction:
Postoperative leak and bleeding from the staple line are potentially serious early complications following laparoscopic sleeve gastrectomy.

Aim:
This study aims to assess the significance of oversewing the staple line after laparoscopic sleeve gastrectomy in preventing leak and bleeding in our group of patients.

Material and methods:
Patients after laparoscopic sleeve gastrectomy were included in the trial. Two different principles of oversewing the staple line (selective vs. mandatory) were analyzed. The design of the trial was retrospective-prospective, non-randomized. Postoperative complications were recorded.

Results:
Between October 2006 and December 2011, 638 laparoscopic sleeve gastrectomies were carried out using standard laparoscopic technique. 297 of the patients belonged to the group with selective oversewing of the staple line. The remaining 341 patients belonged to the group in which the staple line was oversewn in all cases. Both groups of patients were comparable in the basic parameters.

Early postoperative leak affected one patient in both groups, 0.30% versus 0.29% (p = 0.9203), respectively. The rates of postoperative bleeding were 2.7% (selective oversewing) versus 0% (mandatory oversewing) (p = 0.0023), respectively.

Conclusion:
Our study did not demonstrate the impact of oversewing the staple line on the occurrence of postoperative leak. The rates of postoperative bleeding from the resection site were statistically significantly lower in the group with the mandatory oversewing of the staple line.

Keywords:
laparoscopy – gastrectomy – stapler – complications

Zdroje

1. Kasalický M. Pohled na současnou bariatricko-metabolickou chirurgii. Rozhl Chir 2012;91:5–11.

2. Kasalický M. Sleeve gastrectomy – tubulizace žaludku. Rozhl Chir 2013;92:58–60.

3. Almogy G, Crookes PF, Antone GJ. Longitudinal gastrectomy as a treatment for the high- risk super- obese patient. Obes Surg 2004;14:492–497.

4. Ren CJ, Patterson E, Gagner M. Early results of laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients. Obes Surg 2000;10:514–523.

5. Frezza EE, Reddy S, Gee LL, Wachtel MS. Complications After Sleeve Gastrectomy for Morbid Obesity. Obes Surg 2009;19:684–687.

6. Pech N, Meyer F, Lippert H, Manger T, Stroh Ch. Complications and nutrient deficiencies two years after sleeve gastrectomy BMC Surgery 2012;12:13.

7. Stroh Ch, Birk D, Flade- Kuthe R, Frenken M, Herbig B, et al. Bariatric Surgery Working Group Results of Sleeve Gastrectomy - data from a Nationwide Survey on Bariatric Surgery in Germany. Obes Surg 2009;19:632–640.

8. Himpens J, Dobbeleir J, Peeters G. Long-term Results of Laparoscopic Sleeve Gastrectomy for Obesity. Ann Surg 2010;252:319–324.

9. Lalor PF, Tucker ON, Szomstein S, Rosenthal RJ. Complications after laparoscopic sleeve gastrectomy. Surgery for Obesity and Related Diseases 2008;4:33–38.

10. Miguel GP, Azevedo JL, de Souza PH, de Siqueira Neto J, Mustafa F, Zambrana ES, de Carvalho PS. Erosive Esophagitis after Bariatric Surgery: Banded Vertical Gastrectomy versus Banded Roux-en-Y Gastric Bypass, Obes Surg 2011;21:167–172.

11. Rosenthal RJ. International Sleeve Gastrectomy Expert Panel, Diaz AA, Arvidsson D, Baker RS, Basso N, Bellanger D, Boza C, El Mourad H, France M, Gagner M, Galvao-Neto M, Higa KD, Himpens J, Hutchinson CM, Jacobs M, Jorgensen JO, Jossart G, Lakdawala M, Nguyen NT, Nocca D, Prager G, Pomp A, Ramos AC, Rosenthal RJ, Shah S, Vix M, Wittgrove A, Zundel N. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis 2012;8:8–19.

12. Gagner M, Deitel M, Kalberer TL, Erickson AL, Crosby RD. The Second International Consensus Summit for Sleeve Gastrectomy, March 19–21, 2009. Surg Obes Relat Dis 2009;5:476–85.

13. Chopra A, Chao E, Etkin Y, Merklinger L, Lieb J, Delany H. Laparoscopic sleeve gastrectomy for obesity: can it be considered a definitive procedure? Surg Endosc 2012;26:831–7.

14. Chiu S, Birch DW, Shi X, Sharma AM, Karmali S. Effect of sleeve gastrectomy on gastroesophageal reflux disease: a systematic review. Surg Obes Relat Dis 2011;7:510–5.

15. Sammour T, Hill AG, Singh P, Ranasinghe A, Babor R, Rahman H. Laparoscopic sleeve gastrectomy as a single- stage bariatric procedure. Obes Surg 2010;20:271–275.

16. Sakran N, Goitein D, Raziel A, Keidar A, Beglaibter N, Grinbaum R, Matte I, Alfici R, Mahajna A, Waksman I, Shimonov M, Assalia A. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc 2012; DOI 10.1007/ s00464-012-2426-x.

17. Márquez MF, Lozano RB, Ayza MF. Technical controversies in laparoscopic sleeve gastrectomy. Obes Surg 2012;22:182–187.

18. Choi YY, Bae J, Hur KY, Choi D, Kim YJ. Reinforcing the staple line during laparoscopic sleeve gastrectomy: does it have advantages– A meta- analysis. Obes Surg 2012;22:1206–1213.

19. Dapri G, Cadiere GB, Himpens J. Reinforcing the staple line during laparoscopic sleeve gastrectomy: prospective randomized clinical study comparing three different techniques. Obes Surg 2010;20:462–467.

20. Chen B, Kiriakopoulos A, Tsakayannis D, Wachtel MS, Linos D, Frezza EE. Reinforcement does not necessarily reduce the rate of staple line leaks after sleeve gastrectomy. A review of the literature and clinical experiences. Obes Surg 2009;19:166–172.

21. Bellanger DE, Greenway FL. Laparoscopic sleeve gastrectomy, 529 cases without a leak: short- term results and technical considerations. Obes Surg 2011;21:146–150.

22. Kelogrigoris M, Sotiropoulou E, Stathopoulos K, Georgiadou V, Philippousis P, Thanos L. CT- guided percutaneous drainage of infected collections due to gastric leak after sleeve gastrectomy for morbid obesity: initial experience. Cardiovasc Intervent Radiol 2011;34:585–589.

23. Frezza EE, Reddy S, Gee LL, Wachtel MS. Complications after sleeve gastrectomy for morbid obesity. Obes Surg 2009;19: 684–687.

24. Musella M, Milona M, Bellini M, et al. Laparoscopic sleeve gastrectomy. Do we need to oversew the staple line? Ann Ital Chir 2011;82:273–277.