Staple-line reinforcement or not during laparoscopic sleeve gastrectomy: a historical cohort study_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

DENG Shichang , LIU Yang , BAI Jie , LI Gang , WANG Geng , TAO Kaixiong ,  XIA Zefeng

Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, P. R. China;

Corresponding?author：

XIA Zefeng, Email: 188360933@qq.com

Keywords：

laparoscopic sleeve gastrectomy; staple-line reinforcement; complications; obesity

DOI：

10.7507/1007-9424.202310069

Video：

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Objective To explore the necessity of staple-line reinforcement (SLR) during laparoscopic sleeve gastrectomy (LSG) through evaluating its potential benefit and safety. Methods A historical cohort study was conducted in the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology. The consecutive patients underwent LSG for morbid obesity by the same operative team from June 2022 to August 2023 were included, which were assigned into SLR group and un-SLR group according to the SLR or not. Both groups were assessed in terms of the operating time, postoperative hospital stay, total hospital stay, surgical costs, and complications. Results A total of 87 patients underwent the LSG from June 2022 to August 2023, all of whom were successfully completed without any conversion to open surgery. Among them, there were 34 cases in the SLR group and 53 cases in the un-SLR group. There were no statistical differences in the age, gender, body mass index, and so on between the two groups (P>0.05). There were no postoperative complications such as gastric leakage, bleeding, or gastrointestinal stenosis, and no perioperative death, as well as no case of reoperation within 30 d after surgery in all patients of the two groups. And there were no statistical differences in the postoperative hospital stay and total hospital stay between the two groups (P>0.05). However, it was found that the operative time was shorter (P<0.05), the surgical costs and total hospital stay costs were also less (P<0.05) in the un-SLR group as compared with the SLR group. Conclusions Based on the analysis of cases data in this study, there is no added benefit in terms of reducing staple-line leak, bleeding, etc. in adopting SLR during LSG, and the operating time is prolonged and the cost is increased. So the necessity of the SLR or not during LSG needs to be further researched.

Citation： DENG Shichang, LIU Yang, BAI Jie, LI Gang, WANG Geng, TAO Kaixiong, XIA Zefeng. Staple-line reinforcement or not during laparoscopic sleeve gastrectomy: a historical cohort study. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(4): 409-413. doi: 10.7507/1007-9424.202310069 Copy

1.	中國居民營養與慢性病狀況報告(2020年). 營養學報, 2020, 42(6): 521.
2.	王存川, 姜舒文. 肥胖代謝外科的發展與反思. 中華消化外科雜志, 2021, 20(1): 89-93.
3.	Pan XF, Wang L, Pan A. Epidemiology and determinants of obesity in China. Lancet Diabetes Endocrinol, 2021, 9(6): 373-392.
4.	馬鈺棟, 周愛明, 顧德智, 等. 腹腔鏡袖狀胃切除術后早期并發癥的影響因素分析. 中國普外基礎與臨床雜志, 2023, 30(5): 582-586.
5.	Osland E, Yunus RM, Khan S, et al. Late postoperative complications in laparoscopic sleeve gastrectomy (LVSG) versus laparoscopic Roux-en-y gastric bypass (LRYGB): meta-analysis and systematic review. Surg Laparosc Endosc Percutan Tech, 2016, 26(3): 193-201.
6.	Fort JM, Gonzalez O, Caubet E, et al. Management of the staple line in laparoscopic sleeve gastrectomy: comparison of three different reinforcement techniques. Surg Endosc, 2021, 35(7): 3354-3360.
7.	Gagner M, Kemmeter P. Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review. Surg Endosc, 2020, 34(1): 396-407.
8.	中華醫學會外科學分會甲狀腺及代謝外科學組, 中國醫師協會外科醫師分會肥胖和糖尿病外科醫師委員會. 中國肥胖及2型糖尿病外科治療指南(2019版). 中國實用外科雜志, 2019, 39(4): 301-306.
9.	中國醫師協會外科醫師分會肥胖和糖尿病外科醫師委員會. 腹腔鏡袖狀胃切除術操作指南(2018版). 中華肥胖與代謝病電子雜志, 2018, 4(4): 196-201 .
10.	吳愷琪, 曹新嶺, 姚剛, 等. 腹腔鏡袖狀胃切除術治療肥胖癥及其合并癥的研究進展. 中國普外基礎與臨床雜志, 2021, 28(8): 1098-1102.
11.	中國醫師協會外科醫師分會肥胖和糖尿病外科醫師委員會, 中國肥胖代謝外科研究協作組. 中國肥胖代謝外科數據庫: 2022年度報告. 中華肥胖與代謝病電子雜志, 2023, 9(2): 83-91.
12.	林湘杰, 李闖, 樊敬文, 等. 加固釘合線預防腹腔鏡胃袖狀切除術并發癥的研究現狀. 腹部外科, 2022, 35(5): 370-374.
13.	Aiolfi A, Gagner M, Zappa MA, et al. Staple line reinforcement during laparoscopic sleeve gastrectomy: systematic review and network meta-analysis of randomized controlled trials. Obes Surg, 2022, 32(5): 1466-1478.
14.	石曉磊, 孫振, 宋京海. 淺析袖狀胃切除術術后并發癥. 中華肥胖與代謝病電子雜志, 2019, 5(3): 170-173.
15.	胃袖狀切除手術切緣的處理. 中國實用外科雜志, 2019, 39(4): 336, 349.
16.	董光龍, 曹李. 關于袖狀胃切除術中切緣加固問題的思考. 臨床外科雜志, 2020, 28(9): 810-811.
17.	梁輝, 管蔚, 曹慶, 等. 縫合切緣預防袖狀胃切除術并發癥的體會. 腹腔鏡外科雜志, 2016, 21(1): 27-30.
18.	D’Ugo S, Gentileschi P, Benavoli D, et al. Comparative use of different techniques for leak and bleeding prevention during laparoscopic sleeve gastrectomy: a multicenter study. Surg Obes Relat Dis, 2014, 10(3): 450-454.
19.	Cunningham-Hill MA, Mazzei M, Edwards MA, et al. A183—The impact of staple line reinforcement on perioperative staple line leak and bleeding rates following sleeve gastrectomy: an analysis of MBSAQIP data registry. Surg Obes Relat Dis, 2018, 14(11): S64-S65. doi: 10.1016/j.soard.2018.09.099.
20.	Chen B, Kiriakopoulos A, Tsakayannis D, et al. Reinforcement does not necessarily reduce the rate of staple line leaks after sleeve gastrectomy. A review of the literature and clinical experiences. Obes Surg, 2009, 19(2): 166-172.
21.	Musella M, Milone M, Bellini M, et al. Laparoscopic sleeve gastrectomy. Do we need to oversew the staple line?. Ann Ital Chir, 2011, 82(4): 273-277.
22.	朱江帆. 腹腔鏡胃袖狀切除術有必要做胃切緣加強嗎?. 腹部外科, 2022, 35(3): 150-152.
23.	Kasalicky M, Michalsky D, Housova J, et al. Laparoscopic sleeve gastrectomy without an over-sewing of the staple line. Obes Surg, 2008, 18(10): 1257-1262.
24.	Highet A, Johnson EH, Bonham AJ, et al. Cost-effectiveness of staple line reinforcement in laparoscopic sleeve gastrectomy. Ann Surg, 2023, 277(1): 121-126.
25.	Karaman K, Aziret M, Ercan M, et al. A preventive strategy for staple line bleeding in morbidly obese patients undergoing sleeve gastrectomy. J Laparoendosc Adv Surg Tech A, 2017, 27(10): 1015-1021.
26.	Ruiz-Tovar J, Zubiaga L, Mu?oz JL, et al. Incidence of postoperative nausea and vomiting after laparoscopic sleeve gastrectomy with staple line reinforcement with oversewing and staple line inversion vs buttressing material: a randomized clinical trial. Int J Surg, 2018, 59: 75-79.
27.	Gagner M, Hutchinson C, Rosenthal R. Fifth International Consensus Conference: current status of sleeve gastrectomy. Surg Obes Relat Dis, 2016, 12(4): 750-756.
28.	Batman B, Altun H. Benefits of suture reinforcement in laparoscopic sleeve gastrectomy. Surg Laparosc Endosc Percutan Tech, 2019, 29(6): 539-542.
29.	Aggarwal S, Sharma AP, Ramaswamy N. Outcome of laparoscopic sleeve gastrectomy with and without staple line oversewing in morbidly obese patients: a randomized study. J Laparoendosc Adv Surg Tech A, 2013, 23(11): 895-899.
30.	中國醫師協會外科醫師分會肥胖和糖尿病外科醫師委員會(CSMBS). 精準肥胖代謝外科手術中國專家共識(2022版). 中華胃腸外科雜志, 2022, 25(10): 841-851.
31.	朱孝成, 姚立彬. 腹腔鏡胃袖狀切除術術后出血的預防策略. 臨床外科雜志, 2020, 28(9): 814-816.

1. 中國居民營養與慢性病狀況報告(2020年). 營養學報, 2020, 42(6): 521.
2. 王存川, 姜舒文. 肥胖代謝外科的發展與反思. 中華消化外科雜志, 2021, 20(1): 89-93.
3. Pan XF, Wang L, Pan A. Epidemiology and determinants of obesity in China. Lancet Diabetes Endocrinol, 2021, 9(6): 373-392.
4. 馬鈺棟, 周愛明, 顧德智, 等. 腹腔鏡袖狀胃切除術后早期并發癥的影響因素分析. 中國普外基礎與臨床雜志, 2023, 30(5): 582-586.
5. Osland E, Yunus RM, Khan S, et al. Late postoperative complications in laparoscopic sleeve gastrectomy (LVSG) versus laparoscopic Roux-en-y gastric bypass (LRYGB): meta-analysis and systematic review. Surg Laparosc Endosc Percutan Tech, 2016, 26(3): 193-201.
6. Fort JM, Gonzalez O, Caubet E, et al. Management of the staple line in laparoscopic sleeve gastrectomy: comparison of three different reinforcement techniques. Surg Endosc, 2021, 35(7): 3354-3360.
7. Gagner M, Kemmeter P. Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review. Surg Endosc, 2020, 34(1): 396-407.
8. 中華醫學會外科學分會甲狀腺及代謝外科學組, 中國醫師協會外科醫師分會肥胖和糖尿病外科醫師委員會. 中國肥胖及2型糖尿病外科治療指南(2019版). 中國實用外科雜志, 2019, 39(4): 301-306.
9. 中國醫師協會外科醫師分會肥胖和糖尿病外科醫師委員會. 腹腔鏡袖狀胃切除術操作指南(2018版). 中華肥胖與代謝病電子雜志, 2018, 4(4): 196-201 .
10. 吳愷琪, 曹新嶺, 姚剛, 等. 腹腔鏡袖狀胃切除術治療肥胖癥及其合并癥的研究進展. 中國普外基礎與臨床雜志, 2021, 28(8): 1098-1102.
11. 中國醫師協會外科醫師分會肥胖和糖尿病外科醫師委員會, 中國肥胖代謝外科研究協作組. 中國肥胖代謝外科數據庫: 2022年度報告. 中華肥胖與代謝病電子雜志, 2023, 9(2): 83-91.
12. 林湘杰, 李闖, 樊敬文, 等. 加固釘合線預防腹腔鏡胃袖狀切除術并發癥的研究現狀. 腹部外科, 2022, 35(5): 370-374.
13. Aiolfi A, Gagner M, Zappa MA, et al. Staple line reinforcement during laparoscopic sleeve gastrectomy: systematic review and network meta-analysis of randomized controlled trials. Obes Surg, 2022, 32(5): 1466-1478.
14. 石曉磊, 孫振, 宋京海. 淺析袖狀胃切除術術后并發癥. 中華肥胖與代謝病電子雜志, 2019, 5(3): 170-173.
15. 胃袖狀切除手術切緣的處理. 中國實用外科雜志, 2019, 39(4): 336, 349.
16. 董光龍, 曹李. 關于袖狀胃切除術中切緣加固問題的思考. 臨床外科雜志, 2020, 28(9): 810-811.
17. 梁輝, 管蔚, 曹慶, 等. 縫合切緣預防袖狀胃切除術并發癥的體會. 腹腔鏡外科雜志, 2016, 21(1): 27-30.
18. D’Ugo S, Gentileschi P, Benavoli D, et al. Comparative use of different techniques for leak and bleeding prevention during laparoscopic sleeve gastrectomy: a multicenter study. Surg Obes Relat Dis, 2014, 10(3): 450-454.
19. Cunningham-Hill MA, Mazzei M, Edwards MA, et al. A183—The impact of staple line reinforcement on perioperative staple line leak and bleeding rates following sleeve gastrectomy: an analysis of MBSAQIP data registry. Surg Obes Relat Dis, 2018, 14(11): S64-S65. doi: 10.1016/j.soard.2018.09.099.
20. Chen B, Kiriakopoulos A, Tsakayannis D, et al. Reinforcement does not necessarily reduce the rate of staple line leaks after sleeve gastrectomy. A review of the literature and clinical experiences. Obes Surg, 2009, 19(2): 166-172.
21. Musella M, Milone M, Bellini M, et al. Laparoscopic sleeve gastrectomy. Do we need to oversew the staple line?. Ann Ital Chir, 2011, 82(4): 273-277.
22. 朱江帆. 腹腔鏡胃袖狀切除術有必要做胃切緣加強嗎?. 腹部外科, 2022, 35(3): 150-152.
23. Kasalicky M, Michalsky D, Housova J, et al. Laparoscopic sleeve gastrectomy without an over-sewing of the staple line. Obes Surg, 2008, 18(10): 1257-1262.
24. Highet A, Johnson EH, Bonham AJ, et al. Cost-effectiveness of staple line reinforcement in laparoscopic sleeve gastrectomy. Ann Surg, 2023, 277(1): 121-126.
25. Karaman K, Aziret M, Ercan M, et al. A preventive strategy for staple line bleeding in morbidly obese patients undergoing sleeve gastrectomy. J Laparoendosc Adv Surg Tech A, 2017, 27(10): 1015-1021.
26. Ruiz-Tovar J, Zubiaga L, Mu?oz JL, et al. Incidence of postoperative nausea and vomiting after laparoscopic sleeve gastrectomy with staple line reinforcement with oversewing and staple line inversion vs buttressing material: a randomized clinical trial. Int J Surg, 2018, 59: 75-79.
27. Gagner M, Hutchinson C, Rosenthal R. Fifth International Consensus Conference: current status of sleeve gastrectomy. Surg Obes Relat Dis, 2016, 12(4): 750-756.
28. Batman B, Altun H. Benefits of suture reinforcement in laparoscopic sleeve gastrectomy. Surg Laparosc Endosc Percutan Tech, 2019, 29(6): 539-542.
29. Aggarwal S, Sharma AP, Ramaswamy N. Outcome of laparoscopic sleeve gastrectomy with and without staple line oversewing in morbidly obese patients: a randomized study. J Laparoendosc Adv Surg Tech A, 2013, 23(11): 895-899.
30. 中國醫師協會外科醫師分會肥胖和糖尿病外科醫師委員會(CSMBS). 精準肥胖代謝外科手術中國專家共識(2022版). 中華胃腸外科雜志, 2022, 25(10): 841-851.
31. 朱孝成, 姚立彬. 腹腔鏡胃袖狀切除術術后出血的預防策略. 臨床外科雜志, 2020, 28(9): 814-816.

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Staple-line reinforcement or not during laparoscopic sleeve gastrectomy: a historical cohort study

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