The Effect of the Cartridge Used in Laparoscopic Sleeve Gastrectomy on the Development of a Staple-Line Leak (original) (raw)
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Nonsurgical Treatment of Staple Line Leaks after Laparoscopic Sleeve Gastrectomy
Obesity Surgery, 2009
Background Laparoscopic sleeve gastrectomy (LSG) is gaining popularity as a "per se" bariatric procedure due to its effectiveness on weight loss and comorbidity resolution. The most feared and life-threatening complication after LSG is the staple line leak and its management is still a debated issue. Aim of this paper is to analyze the incidence of leak and the treatment solutions adopted in a consecutive series of 200 LSG. Methods From
2020
Introduction. Aim of the study was trying to draw a final flow chart for the management of gastric leaks after laparoscopic sleeve gastrectomy, based on the review of our cases over 10 years' experience. Material and Methods. We retrospectively reviewed all patients who underwent LSG as a primary operation at the Bariatric Unit of Tor Vergata University Hospital in Rome from 2007 to 2015. Results. Patients included in the study were 418. There were 6 staple line leaks (1.44%). All patients with diagnosis of a leak were initially discharged home in good clinical conditions and then returned to A&E because of the complication. The mean interval between surgery and readmission for leak was 13,4 days (range 6-34 days, SD ± 11.85). We recorded one death (16.67%) due to sepsis. The remaining five cases were successfully treated with a mean healing time of the gastric leak of 55,5 days (range 26-83 days; SD ± 25.44). Conclusion. Choosing the proper treatment depends on clinical stabil...
Integrated Approaches for the Management of Staple Line Leaks following Sleeve Gastrectomy
Journal of Obesity, 2017
Introduction. Aim of the study was trying to draw a final flow chart for the management of gastric leaks after laparoscopic sleeve gastrectomy, based on the review of our cases over 10 years’ experience. Material and Methods. We retrospectively reviewed all patients who underwent LSG as a primary operation at the Bariatric Unit of Tor Vergata University Hospital in Rome from 2007 to 2015. Results. Patients included in the study were 418. There were 6 staple line leaks (1.44%). All patients with diagnosis of a leak were initially discharged home in good clinical conditions and then returned to A&E because of the complication. The mean interval between surgery and readmission for leak was 13,4 days (range 6–34 days, SD ± 11.85). We recorded one death (16.67%) due to sepsis. The remaining five cases were successfully treated with a mean healing time of the gastric leak of 55,5 days (range 26–83 days; SD ± 25.44). Conclusion. Choosing the proper treatment depends on clinical stability a...
Management of staple line leaks following sleeve gastrectomy
Surgery for Obesity and Related Diseases, 2014
Background: Leaks after laparoscopic sleeve gastrectomy (LSG) are not very frequent but are a difficult complication that can become chronic. Various treatment options have been suggested but no definitive treatment regimen has been established. The aim of our study is to report leak complications after LSG, their management, and outcomes. Methods: Between June 2008 and October 2013, a total of 539 patients underwent laparoscopic and robot-assisted laparoscopic sleeve gastrectomy at our institution. A retrospective review of a prospectively collected database was performed for all LSG patients, noting the outcomes and complications of the procedure. Results: Fifteen (2.8%) patients presented with a leak after LSG. The diagnosis was made at a mean of 27.2 Ϯ 29.9 days (range, 1-102) after LSG. Eight (53.3%) patients underwent conservative treatment initially and 6 (75.0%) of these patients required stenting as secondary treatment. Although leaks from 3 patients resolved with stenting, the other 3 required restenting and 2 eventually underwent conversion to gastric bypass. Five (33.3%) patients underwent endoscopic intervention, closing the leak with fibrin glue (n ¼ 3) or hemoclips (n ¼ 2). Two (13.3%) patients who were diagnosed with a leak immediately after LSG before discharge had their leak oversewn laparoscopically with an omental patch. Leaks in 9 (60.0%) patients did not heal after the first intervention, and the mean number of intervention required was 2.3 Ϯ 1.7 times (range, 1-7) for the treatment of this condition. Conclusion: Management of leaks after LSG can be challenging. Early diagnosis and treatment is important in the management of a leak. However, it can be treated safely via various management options depending on the time of diagnosis and size of the leak.
Laparoscopic Sleeve Gastrectomy : Is There a Need to Reinforce the Staple-Line ?
Journal of the Royal Medical Services, 2017
Objectives: To assess the effect of staple-line reinforcement on the rate of staple-line leak and bleeding post laparoscopic sleeve gastrectomy. Methods: In this retrospective study we analyzed 326 patients who underwent laparoscopic sleeve gastrectomy at King Hussein Medical Center between January 2010 and April 2016. Staple-line reinforcement using continuous lembert suture method was used in 229 patients (reinforcement group) while it was not used in 97 patients (non-reinforcement group). Patient characteristics, comorbidities, duration of surgery, hospital stay, as well as complications including staple-line leak and bleeding after surgery were obtained, analyzed and compared between the reinforcement and non-reinforcement groups. Results: Patients of the reinforcement group had baseline characteristics and comorbidities similar to those in the non-reinforcement group but had two cases of leak (0.87%) and two cases of bleeding (0.87%).While patients of the non-reinforcement group had one case of leak (1.03%) and five cases of bleeding (5.15%). Although there was no significant difference regarding leak rate between the two groups (P =1.000), bleeding rate was significantly decreased in the reinforcement group (P=0.026). One of the patients with leak died in the reinforcement group while there were no deaths in the non-reinforcement group. Conclusion: According to our results; reinforcement of the staple-line by lembert suture in laparoscopic sleeve gastrectomy reduced the incidence of staple-line bleeding but was associated with prolongation in operation time compared with no staple-line reinforcement. While the difference in leak rate between the two groups was not significant.
Definitive surgical management of staple line leak after sleeve gastrectomy
Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery, 2015
Sleeve gastrectomy (SG) has become a widely adopted bariatric surgical procedure. The most serious complication is staple line leak (SLL), which is potentially life threatening and, in some patients, becomes chronic and difficult to manage. Definitive surgical management of SLL is effective but seldom published in the literature. This study aims to review the outcome of definitive surgical management of SLL after SG, looking at short-term and long-term results. Single surgeon experience based at a tertiary university hospital in Beirut, Lebanon. Retrospective review of records of patients with SLL who underwent definitive surgical treatment by the senior author (B.Y.S.) from January 2008 until December 2013. Ten patients (50% female) underwent definitive surgical repair during the study period. The mean age, weight, and body mass index at the time of SG were 35 years, 121 kg, and 41.5 kg/m(2), respectively. Most leaks (90%) were at the esophagogastric junction. All underwent multipl...
Open Access Macedonian Journal of Medical Sciences
BACKGROUND: Staple line (SL) bleeding and leakage after laparoscopic sleeve gastrectomy (LSG) are still commonly challenging complications. Some surgeons use SL reinforcement (SLR) to decrease the rate of bleeding and leakage, by different methods such as oversewing, fibrin glue, and bovine pericardium, but their role in preventing complications is still controversial. AIM: The aim of this study is to evaluate the incidence of SL bleeding and leakage after LSG by oversewing SL using V-Loc suture material. METHODS: This is a retrospective study carried out on 200 consecutive patients with (body mass index [BMI] >40 kg/m2) or (>35 kg/m2 plus comorbid diseases associated with obesity), divided into two groups according to SLR. Study participants were divided into two equal groups, each one included 100 patients; Group A underwent LSG without SLR, and Group B underwent LSG with SLR. RESULTS: Post-operative SL bleeding was 4% in Group A and 2% in Group B (p = 0.315). Bleeding contr...
The American Surgeon, 2011
Laparoscopic sleeve gastrectomy (LSG) has been recognized as a primary procedure for the surgical management of morbid obesity. Staple-line leaks and hemorrhage are two associated complications. Staple-line buttressing materials have been suggested to decrease these complications. When used during LSG, few published papers exist that compare the incidence of leak or hemorrhage to that of nonreinforced staple-lines. The purpose of this study was to compare the incidence of leak and hemorrhage in patients who did and did not receive reinforcement with Seamguard (W.L. Gore & Associates, Flagstaff, AZ). This is a retrospective analysis of patients undergoing LSG. All patients met National Institutes of Health criteria and each had an extensive preoperative evaluation. Data was collected from inpatient and outpatient medical records. Fifty-nine patients received reinforcement and 80 patients did not. There was no significant difference in mean body mass index, age, or gender make-up betw...
Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery, 2018
Laparoscopic sleeve gastrectomy (LSG) has become a dominant bariatric procedure. In the past, significant leak rates prompted the search for staple line reinforcement (SLR) techniques. Previous analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database for all LSG suggested a detrimental influence of SLR on leak rates and overall morbidity. To investigate the relationship between various SLR techniques and bougie size with 30-day outcomes. Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program-accredited bariatric surgery hospitals. Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program 2015 to 2016 Participant Use File data, primary LSG cases were divided into study groups based on surgical techniques. All variables were reported in the Participant Use File except leak rate and overall morbidity, which had to be derived. Multiple bivariate analyses were used to analyze the ...
Staple line reinforcement during laparoscopic sleeve gastrectomy: Does it affect clinical outcomes?
International Journal of Surgery, 2013
Although laparoscopic sleeve gastrectomy (LSG) is safe and efficacious treatment for morbid obesity, this procedure is associated with major staple line complications including leakage and bleeding. Staple-line reinforcement (SLR) either through suturing or buttressing with biological or synthetic material has been suggested as a method to prevent these complications. A Best Evidence Topic was constructed to address the question of whether SLR reduced these and other complications. MEDLINE, EMBASE and CINAHL searches up to October 2012 returned 97 unique results, of which nine (one meta-analysis, two randomised controlled trials (RCTs), six prospective cohort studies) provided the best evidence to answer this clinical question. We conclude that current evidence suggests that staple-line reinforcement reduces the incidence of leakage and postoperative complications than non-reinforcement but does not significantly reduce bleeding complications. However, we cannot as yet recommend staple-line reinforcement as the strength of the presented evidence is limited by the variable quality of the published studies. The fulllength publication of several abstracts of randomised, controlled trials presented at various recent conferences is awaited. This may provide more data on the effect of staple-line reinforcement on other outcomes largely neglected by currently available studies.