Laparoscopic Sleeve Gastrectomy with Staple Line Concealment: A case series and analysis of outcomes

Janine S Hsu, Samaad Malik, MD, MSc, FRCSC. University of British Columbia

INTRODUCTION: Complications with laparoscopic sleeve gastrectomy (LSG) are rare, but have significant morbidity and mortality. Studies have compared outcomes of staple line reinforcement techniques including buttressing or oversewing with running sutures. However, few have presented cases of reinforcing with sero-muscular sutures that conceal the staple line. This study analyzes outcomes in patients that receive LSG with staple line concealment.

METHODS: A retrospective study on LSGs performed by a single surgeon from 2011 – 2015 at a tertiary care centre. Inclusion criteria: >18 years old, BMI >35 with comorbidities or BMI>40. Exclusion criteria: prior weight-loss surgery.

RESULTS: One hundred and eighty-three patients were included: 158 female (86.3%), 25 male (13.6%) (Table 1, 2). Mean preoperative age 46.8 ± 10.9 years; mean preoperative BMI 44.4 ± 5.73 kg/m2 (range=32.33 kg/ m2 to 65.2 kg/ m2). LSGs were performed using 40Fr or 42Fr bougie, staple line start distance from pylorus: 6cm, and staple lines were concealed with imbricated continuous suture. The mean operative time was 52.1 min ± 11.4min.

Table 1. Major post- operative complication rates

Complication Staple line leak Staple line bleed Stricture Formation
N (%) 0 (0) 1 (0.55) 0 (0)

Table 2. Excess weight loss % post-surgery

Post-operative follow up:

1 month
EWL%(SD)

3 months
EWL%(SD)

6 months
EWL%(SD)

1 year
EWL%(SD)
Total Mean EWL % 15.63 (10.80) 30.57 (11.86) 43.15 (18.78) 46.51 (19.22)
Age group <60years

15.79
(11.52)

30.10
(11.59)

44.70
(18.68)

45.25
(19.66)
Age group ≥ 60years

14.53
(5.97)

30.16
(13.75)

25.95
(13.81)

54.68
(15.80)
p-value (Age groups) 0.74 0.99 0.04 0.37
BMI group <50kg/m2 15.79
(11.26)
30.09
(12.34)
42.47
(44.05)
47.20
(19.21)
BMI group ≥50kg/m2 13.97
(7.31)
30.26
(6.96)
20.00
(13.04)
42.00
(21.62)
p-value (BMI groups) 0.68 0.97 0.84 0.62

CONCLUSIONS: We report low rates of staple line bleeds and staple line leaks with LSG with staple line concealment.  However, a larger prospective trial would be required to further investigate this.

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