Evaluation of complete gastric staple line bioabsorbable reinforcement during laparoscopic sleeve gastrectomy: a propensity score matched analysis.

Abstract

Two feared complications of laparoscopic sleeve gastrectomy (LSG) are bleeding and gastric staple line leak. The aim of this study was to evaluate the safety and efficacy of complete gastric staple line bioabsorbable reinforcement to minimize surgical complications in patients undergoing LSG. Data from consecutive patients undergoing LSG were prospectively collected and retrospectively analyzed. Patients were divided into two groups: (i) complete staple line bioabsorbable reinforcement with standardized perioperative arterial hypertension control; ii) absence of reinforcement with standardized perioperative arterial hypertension control. A propensity score adjustment was performed on factors known to influence LSG postoperative complications. Four hundred thirty-nine patients were matched in each group, with similar preoperative data between groups. Mean operative time significantly decreased when reinforcement was used (84 vs. 104 min; p < 0.001). Intraoperative blood loss was similar. Postoperative bleeding was noted in 17 patients (3.9%) in the no-reinforcement group vs. none in the reinforcement group (p < 0.001). Gastric staple line leak decreased in the reinforcement group (1.4% vs 3.4%), without reaching statistical significance (p = 0.07). Reoperation was required for two patients (0.4%) in the reinforcement group vs. 24 patients (5.4%) in the no-reinforcement group (p < 0.001). Mean length of hospital stay significantly decreased in the reinforcement group (p = 0.044). Complete gastric staple line bioabsorbable reinforcement coupled to perioperative arterial hypertension control leads to significant decrease of bleeding, reoperation rate, and length of hospital stay, as well as non-significant reduction of gastric staple line leak rates in patients with severe obesity undergoing LSG.