Reinforcing the Staple Line During Laparoscopic Sleeve Gastrectomy: Prospective Randomized Clinical Study Comparing Three Different Techniques

Gastric leak and hemorrhage are the most important challenges after laparoscopic sleeve gastrectomy (LSG). In order to reduce these complications, the staple line can be reinforced by absorbable sutures or by the use of glycolide trimethylene carbonate copolymer onto the linear stapler (Gore SeamguardA (R); W.L. Gore & Associates, Inc, Flagstaff, AZ). To our knowledge, there are no randomized studies showing the utility of staple line reinforcement during LSG. The purpose of this study was to randomly compare three techniques in LSG: no staple line reinforcement (group 1), buttressing of the staple line with Gore SeamguardA (R) (group 2), and staple line suturing (group 3). Between January 2008 and February 2009, 75 patients were prospectively and randomly enrolled in the three different techniques of handling the staple line during LSG. The patient groups were similar (NS). Mean operative time to perform the stomach sectioning was 15.9 +/- 5.9 min (group 1), 20.8 +/- 8.1 min (group 2), and 30.8 +/- 10.1 min (group 3) (p < 0.001). Mean total operative time was 47.4 +/- 10.7 min (group 1), 48.9 +/- 18.4 min (group 2), and 59.9 +/- 19.6 min (group 3) (p = 0.02). Mean blood loss during stomach sectioning was 19.5 +/- 21.3 mL (group 1), 3.6 +/- 4.7 mL (group 2), and 16.7 +/- 23.5 mL (group 3) (p < 0.001). Mean total blood loss was 48.9 +/- 67.1 mL (group 1), 32.5 +/- 46.5 mL (group 2), and 61.9 +/- 69.4 mL (group 3) (p = 0.03). Mean number of stapler cartridges used was 5.6 +/- 0.7 (group 1), 5.7 +/- 0.7 (group 2), and 5.8 +/- 0.6 (group 3) (NS). Postoperative leak affected one patient (group 1), two patients (group 2), and one patient (group 3) (NS). Mean hospital stay was 3.6 +/- 1.4 days (group 1), 3.9 +/- 1.5 days (group 2), and 2.8 +/- 0.8 days (group 3) (p = 0.01). In LSG, buttressing the staple line with Gore SeamguardA (R) statistically reduces blood loss during stomach sectioning as well as overall blood loss. No staple line reinforcement statistically decreases the time to perform stomach sectioning and the total operative time. No significant difference is evidenced in terms of postoperative leak between the three techniques of LSG.