Minimizing Omental Bleeding Risk Following Sleeve Gastrectomy: Assessing the Double-line Sealing Technique.

Abstract

Objective: Laparoscopic sleeve gastrectomy (LSG) has become the most commonly performed bariatric procedure due to its technical simplicity and effectiveness. While stapler line reinforcement has significantly reduced hemorrhagic complications, postoperative bleeding remains a concern, particularly from omentum or unidentified sources. The LigaSure device, known for sealing vessels successfully up to 7 mm in diameter, may face challenges in obese patients due to excessive omental fat. This study introduces a double-sealing technique as a simple solution aimed at reducing postoperative bleeding related to patient-specific factors.

Methods: This study conducts a retrospective analysis to evaluate the double-line omental sealing technique in LSG, an intervention aimed at reducing the incidence of postoperative bleeding. We compared outcomes from 222 patients using the double-line sealing (DLS) technique and 297 patients with standard dissection. DLS technique involves creating 2 adjacent rows of seals on the omentum during dissection, aiming to minimize bleeding risks. Patient demographics, including age, sex, body mass index, and comorbidities, were examined, alongside operative time, length of hospital stay, and instances of reoperation. Special attention was given to identifying cases of severe postoperative bleeding, primarily determined by the need for blood transfusion.

Results: No demographic differences emerged between the groups. The study group, which utilized DLS, demonstrated a significantly lower incidence of intraperitoneal severe bleeding (0.45%) compared with the control group (3%). Reoperations were significantly reduced, with only 2 cases (0.67%) in the control group and none in the DLS group. It also correlates with reduced length of hospital stay but increased operative time.

Conclusions: DLS in LSG shows promise in reducing severe postoperative bleeding. Despite these positive initial findings, further studies with larger sample sizes are recommended to fully ascertain the efficacy and safety of this technique.