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Gastric Staple Line Reinforcement With Ligation Clips for Hemostasis in Laparoscopic Sleeve Gastrectomy

INTRODUCTION

In Pakistan and worldwide, there is a lack of literature on the role of ligation clips in controlling hemostasis in laparoscopic sleeve gastrectomy. ligation clips are being used to secure hemostasis and act as staple line reinforcement to prevent intra-operative and postoperative bleeding. Data can be utilized to reflect the role of staple line reinforcement with ligation clips so as to guide surgeons about its safety and efficacy.

METHODOLOGY

This retrospective observational study was conducted at the Shalamar Hospital, Lahore, Pakistan, and included 120 patients. The patients' demographic parameters, BMI, intra-operative and postoperative bleeding in terms of hematemesis, melena, and fall in hemoglobin (Hb) postoperatively were compared to preoperative Hb and recorded.

RESULT

One hundred and twenty cases of laparoscopic sleeve gastrectomy (LSG) were included with a mean age of 44.77±12.05 years. The mean BMI was 52.06±13.85 preoperatively. The mean drop in hemoglobin was 0.04±0.26 with a p-value of 0.07, which is statistically insignificant. Among 120 cases, two (1.7%) patients reported episodes of melena, and four (3.3%) patients reported hematemesis. Postoperative hypotension was recorded in six (5%) patients and eight (6.7%) patients had postoperative tachycardia.

CONCLUSION

This study shows ligation clip application along the staple line is an effective means of hemostasis similar to suture application.

Assisted laparoscopic splenectomy: current concept for treatment of splenic hemangiosarcoma in dogs

BACKGROUND

Hemangiosarcoma (HSA) is a common devastating malignant splenic tumor with high mortalities in dogs. Laparoscopic splenectomy (LS) is safe and gold standard technique for diseases required splenectomy. However, LS operation is a sensitive approach, which requires a restricted control for the vascular sealing procedures.

AIMS

We modified the LS technique through the application of hemostatic clips assisted-LS as an improved approach for the treatment of splenic HSA.

METHODS

Twelve dogs were admitted to the Veterinary Teaching Hospital, Zagazig University, Egypt for investigation of splenic HSA. Abdominal ultrasonography reveals the presence of large hypoechoic splenic masses with no further abnormalities within the peritoneal cavity. Thoracic radiographs, hematological assays, tumor necrosis factor-α (TNF-α) and histopathological investigations were done.

RESULTS

Hemostatic clips assisted-LS showed no major intra or post-operative complications. Laboratory analysis revealed anemia with an increase in TNF-α. Significant increase in platelets count with a slight increase in TNF-α was detected post-operative.

CONCLUSION

Application of the improved hemostatic clips-assisted-LS is cost effective, with shorter operative time, feasible method for vessel sealing, as well as having few complications during the HAS treatment in dogs.