Sn Zafar, MD, MPH, E Wise, MD, M Kligman. University of Maryland Medical Center
Introduction: Staple line treatment during laparoscopic sleeve gastrectomy (LSG) remains a controversial issue among bariatric surgeons. The objective of this study was to compare rates of postoperative bleeding among various accepted methods of staple line reinforcement.
Methods and Procedures: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) 2015 dataset was queried for all LSG patients, excluding those at the extremes of age. Patients were stratified by staple line treatment groups – no treatment (NT), suture oversewing (OVERSEW), buttressing by a commercial product (BUTTRESS) and both buttress and oversew (COMBINATION). The primary outcome measure was postoperative bleeding, defined as the requirement of a blood transfusion within 72 hours or an intervention for ‘bleeding’ as defined by the database’s Participant Use Data File. Multivariate logistic regression modelling, adjusted for patient characteristics and intraoperative factors, was used to compare postoperative bleeding rates between the NT group versus each of the three treatment groups. A separate model compared postoperative bleeding between the OVERSEW and BUTTRESS groups. Bonferroni correction was applied.
Results: In the 98,142 LSG patients meeting selection criteria, 623 (0.63%) patients had postoperative bleeding and 181 (0.18%) required reoperation. Patients received a mean of 2.6 units of blood (range 1 to 12 units. There were 22,601 (23.0%) patients in the NT group, 9,932 (10.1%) patients in the OVERSEW group, 52,958 (54.0%) in the BUTTRESS group, and 12,646 (12.9%) patients in the COMBINATION group. Postoperative bleeding occurred in 0.80% for NT, 0.68% for OVERSEW, 0.57% for BUTTRESS, and 0.55% for the COMBINATION group. Upon multivariate analyses, all treatment groups were less likely to have postoperative bleeding compared to the NT group—OVERSEW (odds ratio [OR] =0.67; 95% confidence interval [CI] = 0.55-0.82), BUTTRESS (OR = 0.68; 95% CI = 0.56-0.82) and COMBINATION (OR = 0.64; 95% C I= 0.48-0.87) (all p<0.01). Subset analysis of BUTTRESS compared to OVERSEW did not reveal a difference in postoperative bleeding rates (OR = 0.85, 95% CI = 0.64-1.13, p=0.83). Additionally, COMBINATION did not reduce bleeding events more than either BUTTRESS or OVERSEW alone (OR = 0.97; 95% CI = 0.73-1.29, p=0.57)
Conclusions: Postoperative bleeding after LSG can be effectively reduced by addressing the staple line. Relative to a NT staple line, the use of OVERSEW or BUTTRESS can decrease the rates of postoperative bleed by up to 33%, and use of these techniques should thus be strongly considered by the bariatric surgeon.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88280
Program Number: S119
Presentation Session: Residents/Fellows Session
Presentation Type: ResFel