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Outcome of Laparoscopic Sleeve Gastrectomy With and Without Staple Line Oversewing in Morbidly Obese Patients: A Randomized Study

医学 外科 袖状胃切除术 体质指数 并发症 泄漏 Roux-en-Y吻合术 减肥 肥胖 胃分流术 内科学 环境工程 工程类
作者
Sandeep Aggarwal,Aditya Sharma,Neelakandan Ramaswamy
出处
期刊:Journal of Laparoendoscopic & Advanced Surgical Techniques [Mary Ann Liebert]
卷期号:23 (11): 895-899 被引量:43
标识
DOI:10.1089/lap.2013.0137
摘要

Introduction: Laparoscopic sleeve gastrectomy (LSG) is a popular bariatric procedure with a low complication rate. Serious complications after LSG include gastric leak and staple line bleeding. In order to reduce these complications, staple line reinforcement has been practiced variably by many surgeons. There is no conclusive evidence to suggest that routine oversewing of the staple line or reinforcement with buttressing material after LSG decreases these complications. We therefore undertook a prospective randomized controlled trial to evaluate the impact of oversewing of the staple line in preventing complications after LSG. Patients and Methods: Sixty patients undergoing LSG were randomly allocated to two groups. In Group A, the entire staple line was reinforced with continuous suturing, and in Group B, no reinforcement was used. Thirty patients were enrolled in each group. Indications for this procedure were morbidly obese (body mass index ≥40 kg/m2) or severely obese (body mass index ≥35 kg/m2) patients with comorbidities including type 2 diabetes mellitus, hypertension, sleep apnea, and osteoarthritis. Complications including gastric leak, bleeding, and stricture were recorded. Results: The demographic parameters were comparable in the two groups. Two cases of early gastric leak occurred in Group B and none in Group A. There was no case of staple line bleeding or stricture in either group, although 1 patient in Group B had bleeding from the omentum that required re-operation. The overall surgical complication rate was 5%. The mean operative time in Group A (139±10 minutes) was significantly greater than in Group B (117±19 minutes) (P=.02). Conclusions: Oversewing of the staple line may lead to reduction in leak rate, although a larger study is required to reach a definitive conclusion. The incidence of staple line bleeding can be minimized by following meticulous technique and adequate compression time after closure of the stapler rather than placing undue emphasis on oversewing and expensive buttressing materials.
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