Sarah S Wong, MD, Toghrul Talishinskiy, MD, Hans J Schmidt, MD, Douglas R Ewing, MD. Hackensack University Medical Center
Introduction: Laparoscopic sleeve gastrectomy is a frequently performed bariatric procedure, achieving long-term weight loss obesity-related co-morbidity remission. Bleeding and leak remain the most common early postoperative complications. Studies demonstrating the benefits of staple line reinforcement remain inconclusive. The goal of this study is to provide a large, single-center comparison of postoperative staple line bleeding and leak rates between reinforced and non-reinforced staple line.
Methods: A retrospective analysis of patients undergoing sleeve gastrectomy between January 2016 and May 2017 was performed. The primary outcome was to compare incidence of postoperative bleeding between reinforced staple line and non-reinforced staple line. Secondary outcomes include comparison of leak, re-operation and transfusion rates. Poisson regression analysis was used to compare incidence rates.
Results: 1171 patients were identified for analysis. Mean age of patients was 43.7 years (range 18-83). Mean BMI of patients was 44.25 kg/m2 (range 28.45-79.60). 815 of 1171 patients were female (70%). Average length of stay was 1.8 days (range 1-18). Overall complication rate was 3.8%, with 43 bleeds (3.7%), 2 leaks (0.17%) and 17 patients requiring return to the OR (1.5%). 5 bleeds were excluded as unrelated to the staple line (4 patients had large port site hematomas and 1 patient had liver hematoma on CT). 781 (66.7%) sleeve gastrectomies were performed with reinforcement and 385 (33.3%) were performed without reinforcement. 15 bleeds were identified in the reinforced group, whereas 22 bleeds were identified in the non-reinforced group (1.9% vs 5.2%, p = 0.0006). 2 leaks occurred in the non-reinforced group and no leaks occurred in the reinforced group (p = 0.0434). Both leaks occurred in patients that were previously identified as having bled around staple line. One patient was taken to the OR for laparoscopic washout. The other was treated with percutaneous drain placement. Both leaks resolved after 1 week of bowel rest and IV antibiotics. One patient in the reinforced group was taken back to the OR for hematoma evacuation, compared to 7 in the non-reinforced group (0.1% vs 1.8%, p = 0.0011). 3 patients in the reinforced group required transfusion compared to 6 patients in the non-reinforced group (0.4% vs 1.6% p = 0.0318). No deaths occurred.
Conclusions: Utilizing staple line reinforcement decreases both postoperative bleeding and leak rates. This large, single-center study demonstrated a 2.7-fold increase in bleeding when non-reinforced staple line is used, as well as an increased risk of leak and return to the OR.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 85216
Program Number: S021
Presentation Session: Bariatrics 1 Session
Presentation Type: Podium
sages_adbutler_leaderboard