Staple Line Complications without Reinforcement,with Oversewing and with Buttressing Using Oxidized Regenerated Cellulose in Laparoscopic Sleeve Gastrectomy,Randomized Comparative Study

Abstract

Background:

Laparoscopic sleeve gastrectomy (LSG) is currently one of the most commonly performed bariatric procedures. Oversewing is one of most commonly performed techniques for staple line reinforcement. Oxidized regenerated cellulose (ORC) is an effective hemostatic agent with several advantages. This study aims to compare the outcomes of no-reinforcement, staple line oversewing and staple line buttressing with ORC in LSG.

Materials and Methods:

Patients were randomized into three groups: 100 patients underwent LSG without reinforcement, 100 patients underwent LSG with oversewing of the staple line, and 100 patients underwent LSG with staple line buttressing by using ORC.

Results:

The mean operative time was longer in patients with staple line oversewing; Group B (53.4 ± 4.21 min) compared with no reinforcement and using the ORC over the staple line (p-value <0.01). The postoperative bleeding is significantly (p < 0.05) reduced with oversewing and with using ORC compared with the control group.

Conclusion:

Oversewing of the staple line during LSG is a nonexpansive and easy method to decrease bleeding. However, it is time-consuming, associated with a higher incidence of staple line hematoma and postoperative vomiting. Using ORC is effective in reducing staple line bleeding in LSG compared with the control group.