Lainas Panagiotis, Kassir Radwan, Triantafyllou Evangelia, Dammaro Carmelisa, Safieddine Maissa, Devaquet Niaz, Dagher Ibrahim
Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, Paris-Saclay University, Clamart, France.
Department of Metabolic & Bariatric Surgery, Metropolitan Hospital, Athens, Greece.
Updates Surg. 2025 Jul 21. doi: 10.1007/s13304-025-02326-7.
Two feared complications of laparoscopic sleeve gastrectomy (LSG) are bleeding and gastric staple line leak. The aim of this study was to evaluate the safety and efficacy of complete gastric staple line bioabsorbable reinforcement to minimize surgical complications in patients undergoing LSG. Data from consecutive patients undergoing LSG were prospectively collected and retrospectively analyzed. Patients were divided into two groups: (i) complete staple line bioabsorbable reinforcement with standardized perioperative arterial hypertension control; ii) absence of reinforcement with standardized perioperative arterial hypertension control. A propensity score adjustment was performed on factors known to influence LSG postoperative complications. Four hundred thirty-nine patients were matched in each group, with similar preoperative data between groups. Mean operative time significantly decreased when reinforcement was used (84 vs. 104 min; p < 0.001). Intraoperative blood loss was similar. Postoperative bleeding was noted in 17 patients (3.9%) in the no-reinforcement group vs. none in the reinforcement group (p < 0.001). Gastric staple line leak decreased in the reinforcement group (1.4% vs 3.4%), without reaching statistical significance (p = 0.07). Reoperation was required for two patients (0.4%) in the reinforcement group vs. 24 patients (5.4%) in the no-reinforcement group (p < 0.001). Mean length of hospital stay significantly decreased in the reinforcement group (p = 0.044). Complete gastric staple line bioabsorbable reinforcement coupled to perioperative arterial hypertension control leads to significant decrease of bleeding, reoperation rate, and length of hospital stay, as well as non-significant reduction of gastric staple line leak rates in patients with severe obesity undergoing LSG.
腹腔镜袖状胃切除术（LSG）有两种令人担忧的并发症，即出血和胃吻合钉线渗漏。本研究的目的是评估完全胃吻合钉线生物可吸收加固术在减少接受LSG患者手术并发症方面的安全性和有效性。前瞻性收集并回顾性分析连续接受LSG患者的数据。患者分为两组：（i）采用标准化围手术期动脉高血压控制的完全吻合钉线生物可吸收加固术；（ii）采用标准化围手术期动脉高血压控制但未进行加固术。对已知影响LSG术后并发症的因素进行倾向评分调整。每组匹配439例患者，两组术前数据相似。使用加固术时，平均手术时间显著缩短（84分钟对104分钟；p＜0.001）。术中失血量相似。未加固组有17例患者（3.9%）出现术后出血，而加固组无术后出血（p＜0.001）。加固组胃吻合钉线渗漏率有所下降（1.4%对3.4%），但未达到统计学显著性（p = 0.07）。加固组有2例患者（0.4%）需要再次手术，未加固组有24例患者（5.4%）需要再次手术（p＜0.001）。加固组的平均住院时间显著缩短（p = 0.044）。对于接受LSG的严重肥胖患者，完全胃吻合钉线生物可吸收加固术联合围手术期动脉高血压控制可显著降低出血、再次手术率和住院时间，同时胃吻合钉线渗漏率也有非显著性降低。
