Comparing Reinforcement Options for the Staple Line of Laparoscopic Sleeve Gastrectomy

Objective: To compare three reinforcement options (suture, fibrin glue, and no reinforcement) for staple line reinforcement of patients undergoing laparoscopic sleeve gastrectomy.Study Design: An experimental study.Place and Duration of Study: Ortadogu Hospital, Adana, Turkey, from 2013 to 2017.Methodology: The inclusion criteria were patients with BMI >40 Kg/m 2 or >35 Kg/m 2 (if there were comorbid diseases associated with obesity).The exclusion criteria were patients who were older than 65 years or had a bariatric procedure earlier.The patients were placed in three groups.Group 1 had no staple line reinforcement, group 2 had fibrin glue on the staple line, and group 3 had barbed continued suture on the staple line.The primary endpoints included stenosis, bleeding, and postoperative leaks.The secondary outcomes included total operation time and time for staple line reinforcement.Values of p<0.05 were deemed significant for all statistical tests.Results: The mean time to perform the staple line reinforcement was significantly higher in group 3 (22.05±2.83 minutes) than in group 2 (fibrin glue, 10.86 ±2.15 minutes, p<0.001).The mean total operation times were significantly different between all three groups; 70.8 ±5.4 minutes for group 1, 74.7 ±6.2 minutes for group 2, and 81.2 ±3.0 minutes for group 3 (p<0.001).The groups had no statistical differences regarding complications. Conclusion:The use of fibrin glue and barbed continuous suture for staple line reinforcement during laparoscopic sleeve gastrectomy had no effect on post-or per-operative hemorrhage and leakage; however, these procedures significantly extended the operation time.