Leakage Rate After Laparoscopic Sleeve Gastrectomy; How Much Affected by Staple-line Reinforcement?

Abstract

Background: LSG is an easy and safe technique with a shorter learning curve. The risk of staple-line bleeding, leakage, and dehiscence are much higher because of long staple-line. This study was carried out to detect the importance of staple-line reinforcement. Methods: Between April 2010 and September 2013, 166 consecutive patients with a diagnosis of morbid obesity based on the guidelines issued by IFSO who underwent LSG and completed their follow-up for a minimum one year were classified into; (group A) 84 patients with and (group B) 82 patients without staple-line reinforcement at Alexandria University. Outcome parameters including; leakage, bleeding, operative time, surgical complications, hospital stay, and follow-up details, were collected. Results: The demographic parameters were comparable in the two groups. No conversion to open surgery was detected. There was insignificant leakage rate as 2(2.4%) cases were found in group B and none in group A (P=0.86). There was insignificant difference between both groups as regard bleeding from staple-line, short gastric vessels or splenic tear. No stenosis was found in either group. The mean operative time in group A (99.7±19.1 minutes) was significantly longer than in group B (76.3±9.5 minutes) (P=0.015). Hospital stay was significantly prolonged in group B (2.5±4.9 days) than group A (1.95±0.4 days) (P=0.031). No significant difference was found regarding the other outcome parameters. Conclusions: LSG is an effective and safe bariatric procedure with low incidence of complications and mortality in our experience. Reinforcement of the staple-line did not have any additional benefit, although a larger study is required to reach a definitive conclusion.