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Bioabsorbable Glycolide Copolymer is Effective in Reducing Staple Line Bleeding in Sleeve Gastrectomy

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Abstract

Background

Postoperative bleeding from the staple line after sleeve gastrectomy occurs in 2–8% of patients and it is associated with increased length and cost of hospitalization and may demand reoperation to gain hemostasis. Reinforced staplers are used by bariatric surgeons to reduce the incidence of postoperative leak but can have a role in avoiding bleeding. The aim of this study is to analyze the effects of reinforcement on the whole gastric staple line during sleeve gastrectomy on postoperative bleeding.

Methods

Four hundred forty-eight consecutive patients undergoing sleeve gastrectomy from November 2012 to April 2019 were divided into two groups. In the Top-only group only the top staple shot was realized with reinforced material (GORE® SEAMGUARD®) while in the Bottom-to-Top group, patients received full staple line reinforcement. Statistical analysis focused on postoperative leak and bleeding, and length of stay; a propensity score matching analysis was performed to reduce between-group characteristics imbalance.

Results

One hundred forty-five (Top-only) and 303 (Bottom-to-Top) patients were included. Four (2.8%) patients in the Top-only group and none in the Bottom-to-Top group experienced severe bleeding (p = 0.004); the difference was still significant after propensity score matching. Length of stay was significantly shorter for the Bottom-to-Top group before and after propensity score matching (4 vs. 5 days, p < 0.001).

Conclusions

Staple line buttressing reduces the incidence of severe postoperative bleeding when performed on the whole staple line, and it is associated with a shorter hospitalization.

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Authors and Affiliations

  1. Université Côte d’Azur, Nice, France

    Antonio Iannelli & Céline Drai

  2. Digestive Surgery and Liver Transplantation Unit, Centre Hospitalier Universitaire de Nice, Archet 2 Hospital, 151 Route Saint Antoine de Ginestière, BP 3079, Nice, France

    Antonio Iannelli, Antonio Castaldi & Céline Drai

  3. Inserm, U1065, Team 8 “Hepatic Complications of Obesity and Alcohol”, Nice, France

    Antonio Iannelli

  4. Service de Chirurgie Digestive, Centre Hospitalier d’Antibes Juan-Les-Pins, 107, av. de Nice, 06600, Antibes, France

    Andrea Chierici

  5. Digestive Surgery Unit, Centre Hospitalier Universitaire de Guadeloupe, 97159, Pointe à Pitre, Guadeloupe

    Anne-Sophie Schneck

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  1. Antonio Iannelli
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  4. Céline Drai
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  5. Anne-Sophie Schneck
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Corresponding author

Correspondence to Antonio Iannelli.

Ethics declarations

Ethics approval and consent to participate

This study has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. No approbation of research ethics board was deemed necessary due to the retrospective nature of the study and the complete anonymization of the data. Informed consent does not apply.

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The authors declare no competing interests.

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Key points

• Postoperative bleeding after sleeve gastrectomy is responsible for moderate morbidity.

• Different stapling techniques and materials have been used to reduce postoperative bleeding.

• Staple line buttressing for the whole gastric line resection reduces severe postoperative bleeding and length of stay.

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Iannelli, A., Chierici, A., Castaldi, A. et al. Bioabsorbable Glycolide Copolymer is Effective in Reducing Staple Line Bleeding in Sleeve Gastrectomy. OBES SURG 32, 2605–2610 (2022). https://doi.org/10.1007/s11695-022-06152-3

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  • DOI: https://doi.org/10.1007/s11695-022-06152-3

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