Prevention of the stapler line leak after laparoscopic sleeve gastrectomy in patients with morbid obesity

Abstract

Obesity has become a global pandemic, leading to increased morbidity and mortality among patients, both young and old. Bariatric surgery is the most effective method for treating pathological obesity. Laparoscopic sleeve gastrectomy has become the most popular bariatric procedure worldwide. However, staple line leak is the most dreaded postoperative complication following laparoscopic sleeve gastrectomy. In order to reduce the incidence of this complication, most surgeons prefer to reinforce the staple line. However, there is no compelling evidence to suggest that peritonealization of the staple line or the use of coated stapler cartridges during laparoscopic sleeve gastrectomy reduces the risk of leakage. Therefore, we conducted a retrospective analysis to assess the impact of coated stapler cartridges on preventing staple line leaks. The aim of the study. To evaluate the effect of using stapler with coating on preventing staple line leaks during laparoscopic sleeve gastrectomy in patients with morbid obesity. Materials and methods. This was a retrospective analysis of 45 patients who underwent laparoscopic sleeve gastrectomy using endostapler from Medtronic (Endo GIA™) without additional reinforcement (Group I) and 46 patients who underwent a similar procedure using endostapler from Medtronic (Endo GIA™) stapler with coating (Group II). Both patient groups were homogeneous in terms of demographic characteristics. We compared the duration of surgery, intraoperative blood loss, length of hospital stay, and the incidence of staple line leak. Results. The incidence of staple line leak was statistically significantly higher in Group I compared to Group II (5/40 vs. 0/46; χ2 = 5.4, p = 0.021). This resulted in a statistically significant increase in blood loss (U = 706; p = 0.006), prolonged total operation time (U = 310; p = 0.001), and extended postoperative hospital stay (U = 245; p = 0.001) in Group I. The median time to healing of the leak was 32 [20; 59] days. No patient died. Conclusions. Using the endostapler with purple cartridges with coating from Medtronic during laparoscopic sleeve gastrectomy significantly reduced postoperative leak rate and significantly decreased postoperative hospital stay.