DOI: http://dx.doi.org/10.18203/2349-2902.isj20192354

Stapling technology with triple-row and enhanced staple configurations evaluated in a series of 124 consecutive laparoscopic vertical gastrectomies

Alessandro Bianchi, Alberto Pagan-Pomar, Marina Jimenez-Segovia, Carla Soldevila-Verdeguer, Jaume Bonnin-Pascual, José Antonio Martinez-Corcoles, Xavier Francesc González-Argenté

Abstract


Background: Laparoscopic sleeve gastrectomy (LSG) is a procedure frequently used to treat morbid obesity, due to its simplicity compared to other bariatric techniques. However, LSG can lead to serious complications, such as gastric leakage and bleeding from the staple line. To reduce these complications, seroserosal reinforcement of the mechanical suture line after gastrectomy is generally recommended. In recent decades, studies have focused on the safety of anastomosis with staples, especially compared to manual sewing techniques. Since studies on the improvement of stapling technology are limited, this study arises to compare the clinical results of staple line oversewing versus stapling technology with triple-row and enhanced staple configurations in laparoscopic sleeve gastrectomy.

Methods: A retrospective review from a prospectively maintained database of 124 laparoscopic vertical gastrectomies performed at single centre between March 2010 and December 2016. Patients were divided into two groups, with comparable anthropometric parameters and inclusion criteria. Seroserosal reinforcement was used in the first group, and stapling technology with triple-row and enhanced staple configurations in the second. Rates of anastomotic leakage, bleeding, reoperation, and 30-day mortality were compared.

Results: In Group 1 the average surgical time was 125 min, whereas in Group 2 it was 87 min. No differences were found between the two groups regarding leakage or bleeding of the staple line.

Conclusions: The use of triple-row stapling devices during laparoscopic vertical gastrectomy enables surgical time to be reduced. Further high-quality studies to evaluate the efficacy and effectiveness of stapling technology with triple-row and enhanced staple configurations are needed.


Keywords


Sleeve gastrectomy, Stapler, Staple lines, Staple line bleed, Staple line leak, Staple line oversewing

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References


Zeebregts CJ, Heijmen RH, van den Dungen JJ, van Schilfgaarde R. Non-suture methods of vascular anastomosis. Br J Surg. 2003;90(3):261–71.

Konstantinov IE. Circular vascular stapling in coronary surgery. Ann Thorac Surg. 2004;78(1):369–73.

Hasegawa S, Nakayama S, Hida K, Kawada K, Sakai Y. Effect of Tri-Staple Technology and Slow Firing on Secure Stapling Using an Endoscopic Linear Stapler. Dig Surg. 2015;32(5):353–60.

van Vugt JLA, Tegels JJW, Derikx JPM, Visschers RGJ, Stoot JHMB. First experiences with the Radial Reload with Tri-stapleTM technology in low rectal surgery. Int J Surg. 2015;14:23–7.

Fegelman E, Knippenberg S, Schwiers M, Stefanidis D, Gersin KS, Scott JD, et al. Evaluation of a Powered Stapler System with Gripping Surface Technology on Surgical Interventions Required During Laparoscopic Sleeve Gastrectomy. J Laparoendosc Adv Surg Tech A. 2017;27(5):489–94.

Sammour T, Hill AG, Singh P, Ranasinghe A, Babor R, Rahman H. Laparoscopic sleeve gastrectomy as a single-stage bariatric procedure. Obes Surg. 2010;20(3):271–5.

Carlin AM, Zeni TM, English WJ, Hawasli AA, Genaw JA, Krause KR, et al. The comparative effectiveness of sleeve gastrectomy, gastric bypass, and adjustable gastric banding procedures for the treatment of morbid obesity. Ann Surg. 2013;257(5):791–7.

Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis. 2009;5(4):469–75.

Gentileschi P, Camperchioli I, D’Ugo S, Benavoli D, Gaspari AL. Staple-line reinforcement during laparoscopic sleeve gastrectomy using three different techniques: a randomized trial. Surg Endosc. 2012;26(9):2623–9.

Shikora SA, Mahoney CB. Clinical Benefit of Gastric Staple Line Reinforcement (SLR) in Gastrointestinal Surgery: a Meta-analysis. Obes Surg. 2015;25(7):1133–41.

Peel AL, Taylor EW. Proposed definitions for the audit of postoperative infection: a discussion paper. Surgical Infection Study Group. Ann R Coll Surg Engl. 1991;73(6):385–8.

Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010;252(2):319–24.

Kwiatkowski A, Janik MR, Paśnik K, Stanowski E. The effect of oversewing the staple line in laparoscopic sleeve gastrectomy: randomized control trial. Wideochir Inne Tech Maloinwazyjne. 2016;11(3):149–55.

Wang H, Lu J, Feng J, Wang Z. Staple line oversewing during laparoscopic sleeve gastrectomy. Ann R Coll Surg Engl. 2017;99(7):509–14.

Sarkhosh K, Birch DW, Sharma A, Karmali S. Complications associated with laparoscopic sleeve gastrectomy for morbid obesity: a surgeon’s guide. Can J Surg. 2013;56(5):347–52.

Consten ECJ, Gagner M, Pomp A, Inabnet WB. Decreased bleeding after laparoscopic sleeve gastrectomy with or without duodenal switch for morbid obesity using a stapled buttressed absorbable polymer membrane. Obes Surg. 2004;14(10):1360–6.

Serra C, Baltasar A, Andreo L, Pérez N, Bou R, Bengochea M, et al. Treatment of gastric leaks with coated self-expanding stents after sleeve gastrectomy. Obes Surg. 2007;17(7):866–72.

Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA, Arvidsson D, Baker RS, Basso N, et al. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8(1):8–19.

Gagner M, Buchwald JN. Comparison of laparoscopic sleeve gastrectomy leak rates in four staple-line reinforcement options: a systematic review. Surg Obes Relat Dis. 2014;10(4):713–23.

D’Ugo S, Gentileschi P, Benavoli D, Cerci M, Gaspari A, Berta RD, 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):450–4.

Giuliani A, Romano L, Papale E, Puccica I, Di Furia M, Salvatorelli A. Complications post-laparoscopic sleeve gastric resection: review of surgical technique. Minerva Chir. 2019;13.

Taha O, Abdelaal M, Talaat M, Abozeid M. A Randomized Comparison Between Staple-Line Oversewing Versus No Reinforcement During Laparoscopic Vertical Sleeve Gastrectomy. Obes Surg. 2018;28(1):218–25.

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 Laparoendoscopic & Advanced Surg Tech. 2013;23(11):895–9.

Sroka G, Milevski D, Shteinberg D, Mady H, Matter I. Minimizing Hemorrhagic Complications in Laparoscopic Sleeve Gastrectomy--a Randomized Controlled Trial. Obes Surg. 2015;25(9):1577–83.