Staple-Line Reinforcement with a Thrombin Matrix During Laparoscopic Sleeve Gastrectomy for Morbid Obesity: A Case Series

Abstract

Abstract

Background:

Laparoscopic sleeve gastrectomy (LSG) represents a valid option for morbidly obese patients, either as a primary or as a staged procedure. Staple-line reinforcement (SLR) is strongly advocated to decrease the chance of bleeding. The aim of this article is to report our experience with a new technique of SLR using a thrombin–gelatin matrix in a series of morbidly obese patients subjected to LSG.

Subjects and Methods:

Patients subjected to LSG using a thrombin–gelatin matrix for SLR from April 2010 to April 2011 were included in the study. Each patient's record was registered and prospectively collected for the analysis.

Results:

Seventy-four patients were subjected to LSG using a thrombin matrix for SLR. There were 56 female and 18 male subjects with a mean age of 44.8 years (range, 16–64 years). Mean preoperative body mass index was 46.2 kg/m² (range, 40–72 kg/m²). Mean operative time was 74.4 minutes (range, 58–96 minutes). Mean time for application of the thrombin matrix was 4.8 minutes (range, 3.2–6.6 minutes). Mean postoperative hospital stay was 3.4 days (range, 2–62 days). Mean follow-up was 8.2 months (range, 3–12 months). Mean postoperative body mass index was 36.2 kg/m² (range, 30–42 kg/m²), and mean percentage excess weight loss was 34.2% (range, 28.4%–42.8%). We observed two major postoperative complications (2.7%): One gastric stump leak (1.3%) and one major bleeding from the trocar site (1.3%), both successfully treated by laparoscopic re-exploration.

Conclusion:

LSG with a thrombin matrix for SLR is a safe operation and a valid alternative to other well-established techniques.