Sleeve Gastrectomy Can Be Safely Performed Without Staple Line Reinforcement

Cullen O Carter, MD1, Matthew Tufts2, Myron S Powell2, Stephen S McNatt2, Adolfo Z Fernandez2. 1Boston Medical Center, 2Wake Forest Baptist Medical Center

INTRODUCTION:  Since 2012, sleeve gastrectomy has been the most common bariatric surgical procedure performed in the United States.  According to recent surveys, 79% of bariatric surgeons perform some form of staple-line reinforcement, with 57% using staple-line buttressing with a biologic material and 43% oversewing the staple line.  Buttressing with biologic material and oversewing can add significant cost and time, respectively, to the surgical procedure.  The purpose of this study was to review the experience of sleeve gastrectomy at a single institution performed without any form of staple-line reinforcement.

METHODS AND PROCEDURES:  A retrospective chart review of all patients who underwent sleeve gastrectomy performed by two surgeons at a single institution was undertaken.  Operative note, laboratory values, vital signs, progress notes, and discharge summaries were reviewed, looking specifically for evidence of bleeding or staple-line leak.

RESULTS: A total of 345 patients underwent sleeve gastrectomy over a period of three years.  The perioperative 30-day mortality rate was 0%.  Leak rate was 0%.  Eight patients (2.3%) showed clinical signs of bleeding.  The most commmon signs were tachycardia, hypotension, orthostasis, syncope, and oliguria.  The average decrease in hemoglobin in this group was 4.9 g/dl.  Three patients required intervention for bleeding (0.9%).  The first required reoperation with control of a pulsatile stable line bleed and transfusion of 1 unit RBC.  The second required transfusion of 1 unit RBC but did not require reoperation.  The third patient had a subcutaneous bleed into a single incision port site which required reoperation for hematoma evacuation, but did not require peritoneal entry or transfusion.

CONCLUSION: Sleeve gastrectomy can be safely performed without staple line reinforcement or buttressing, with a very low rate of clinically signficant bleeding.

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