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    Staple Line Treatment and Bleeding After Laparoscopic Sleeve Gastrectomy

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    Author
    Zafar, S.N.
    Felton, J.
    Miller, K.
    Date
    2018
    Journal
    JSLS : Journal of the Society of Laparoendoscopic Surgeons
    Publisher
    Society of Laparoendoscopic Surgeons
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://dx.doi.org/10.4293/JSLS.2018.00056
    Abstract
    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.
    Keyword
    Bariatric surgery
    Complications
    Outcomes
    Quality
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85059497470&doi=10.4293%2fJSLS.2018.00056&partnerID=40&md5=aba2ce9da0565d0c4a29ea6ab16502f9; http://hdl.handle.net/10713/9055
    ae974a485f413a2113503eed53cd6c53
    10.4293/JSLS.2018.00056
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