A Prospective Observational Study Investigating Postoperative Hemorrhage After Laparoscopic Sleeve Gastrectomy Using Bipolar Seal and Cut Caiman (Aesculap AG)

Abstract

Objective This study investigated postoperative hemorrhage after laparoscopic sleeve gastrectomy using the Bipolar Seal and Cut Caiman (Aesculap AG, Tuttlingen, Germany). Summary of background data Besides staple line leakage, postoperative hemorrhage (POH) is the most discussed acute complication after laparoscopic sleeve gastrectomy (LSG). POH is the second most important acute complication following LSG, with staple line leakage being the first. POH is reported in up to 5% of cases after LSG. Sufficient vessel sealing is crucial in avoiding later complications of POH during mobilization of the greater curvature. This study investigated bleeding complications after LSG using the Advanced Bipolar Seal and Cut instrument Caiman 5. Methods All LSGs were performed in a highly standardized manner according to the standard operating procedure of our Center of Reference for Bariatric Surgery using the Caiman. Primary outcome was the incidence of POH, defined as the need for revisional surgery and/or blood transfusions. Secondary outcomes were hemoglobin levels preoperatively at the day of surgery (POD 0) and at postoperative days (PODs) 1 and 2, volume and duration of drainage at PODs 0 to 2, procedure time, and length of hospital stay. Results A total of 100 patients who had undergone LSG from April 2016 to September 2017 were consecutively included in the study. Patients with contraindications to undergo LSG or those who were not able to give consent were excluded. Four patients needed treatment because of POH; in 3 of them surgery became necessary. Average operation time was 68.5 minutes and total volume of drainage was 186 mL. The drain stayed in situ for 2.2 days (mean). Average hospital stay was 3.6 days. Conclusion In our study group of 100 LSG procedures POH was 4%, which is comparable to data reported in the literature. Operation time, volume and duration of drainage, and length of hospital stay were not prolonged. LSG using Caiman is feasible and shows results comparable to those of other vessel-sealing instruments at our center.