Staple-line reinforcement during laparoscopic sleeve gastrectomy using three different techniques: a randomized trial
Surgical Endoscopy, 03/27/2012

Gentileschi P et al. – Staple line reinforcement (SLR) with either polyglycolide acid with trimethylene carbonate or gelatin fibrin matrix is faster compared with oversewing. No significant differences were observed regarding postoperative staple–line complications.

• From April 2010 to April 2011, patients submitted to LSG were randomly selected for the following three different techniques of SLR: oversewing (group A); buttressed transection with a polyglycolide acid and trimethylene carbonate (group B); and staple–line roofing with a gelatin fibrin matrix (group C).
• Primary endpoints were reinforcement operative time, incidence of postoperative staple–line bleeding, and leaks.
• Operative time was calculated as follows: oversewing time in group A; positioning of polyglycolide acid and trimethylene carbonate over the stapler in group B; and roofing of the entire staple line in group C.

• A total of 120 patients were enrolled in the study (82 women and 38 men).
• Mean age was 44.6 ± 9.2 (range, 28–64) years. Mean preoperative body mass index was 47.2 ± 6.6 (range, 40–66) kg/m².
• Mean time for SLR was longer in group A (14.2 ± 4.2 (range, 8–18) minutes) compared with group B (2.4 ± 1.8 (range, 1–4) minutes) and group C (4.4 ± 1.6 (range, 3–6) minutes; P < 0.01).
• Four major complications were observed (3.3 %): one leak and one bleeding in group A; one bleeding in group B; and one leak in group C, with no significant differences between the groups.
• No mortality was observed.