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Staple Line Reinforcement

Study supports staple line reinforcement for LSG

Patients who had reinforcement material reported no postoperative staple line leaks or bleeding
The no-reinforcement group had three leaks (p=0.045) and one case of bleeding
The reinforcement-material group also had a significantly shorter operating time and smaller bougie size

The use of the bioabsorbable staple line reinforcement material may decrease life-threatening leaks after laparoscopic sleeve gastrectomy (LSG), according to a single centre study of over 500 patients published in Obesity Surgery.

Gastric leakage from the staple line is a life-threatening complication of LSG, however there is some debate as to whether buttressing the staple line with a reinforcement material reduces leaks. Several methods of reinforcement are utilised for preventing leaks and bleeding after LSG, such as oversewing the staple line, applying a fibrin sealant, and using a buttressing material.

In addition, the study authors from The Life Weight Loss Centre Liverpool, NSW, Australia, note that in addition to the method of reinforcement other technical aspects of the procedure such as bougie size and distance from the pylorus need to be taken into consideration.

Study

Therefore, the researchers retrospectively reviewed 518 medical records of all patients who underwent LSG at their centre between September 2007 and December 2011. They note that patients treated before August 2009 did not receive the staple line reinforcement material (n=186), whereas all patients treated afterward did (n=332).

They used the Gore Seamguard Bioabsorbable Staple Line Reinforcement (WL Gore & Associates), a synthetic bioabsorbable material composed of the copolymer polyglycolic acid/trimethylene carbonate.

Results

Follow up data was available from 409 patients at six months postoperatively, 329 patients at one year and 258 patients at two years. %EWL was 67.1% at six months, 81.2% at one year and 83.8 % at two years.

Patients who had reinforcement material reported no postoperative staple line leaks or bleeding. The no-reinforcement group had three leaks (p=0.045) and one case of bleeding.

The reinforcement-material group also had a significantly shorter operating time and smaller bougie size, as well as a significantly higher rate of hiatal hernia repairs. The overall adverse-event rate was 1.7%.

“We believe that use of a smaller bougie produces greater weight loss, but we are aware that employing a small bougie may increase the risk of staple line leaks caused by an increase in intraluminal pressure, especially at the angle of His,” the authors write. “However, our results provide new evidence that using the PGA/TMC reinforcement material mitigates that risk.”

Conclusion

“Patients in whom synthetic PGA/TMC staple line reinforcement material was applied during LSG had no postoperative leaks or haemorrhages from the staple line,” the authors conclude. “The difference in leak rate between the reinforcement-material group and the no-reinforcement-material group was significant (p = 0.045).”

They also note that using a bougie that was 40F or smaller and limiting the antrum size to 2 to 4cm resulted in ‘excellent’ short-term %EWL results at six months and one and two years after surgery. Further, the resolution of or improvement in T2DM and hypertension occurred in 89 and 72 % patients, respectively.

To view this paper, please click here

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