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Dalkılıç MS, Gençtürk M, Şişik A, Erdem H. Enhancing bariatric surgery safety for patients refusing blood transfusions: a specialized protocol with comprehensive technical measures. Updates Surg 2024:10.1007/s13304-024-01912-5. [PMID: 38865002 DOI: 10.1007/s13304-024-01912-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/03/2024] [Indexed: 06/13/2024]
Abstract
Bariatric surgery has become a leading treatment for obesity, with techniques such as Laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) demonstrating notable success in sustained weight loss and improved quality of life. Technological advancements and improved techniques have enhanced the safety of these procedures. The surgical procedures of Jehovah's Witnesses, who refuse blood transfusions as part of their beliefs, pose unique challenges and have rarely been addressed in the context of bariatric surgery. This report aimed to investigate the safety of bariatric surgery in patients who refuse blood transfusion, with an established protocol to minimize the risk of bleeding. We examined the prospectively collected data of Jehovah's Witness patients who underwent bariatric surgery from 2019 to 2023. The surgeries were conducted following a protocol that included specific measures to prevent bleeding. Data were reviewed for demographics, anthropometrics, comorbidities, preoperative medications, operative time, blood loss, length of hospital stay, hemoglobin level, drainage volume, tranexamic acid use, and postoperative 30-day complications. Eleven Jehovah's Witness patients underwent bariatric surgery, including 10 LSG and 1 LRYGB. A patient with iron deficiency anemia underwent intravenous iron treatment before the surgery. There were no intraoperative complications or major postoperative complications. All patients maintained stable hemodynamics postoperatively. Only one patient encountered nausea-vomiting, classified as a minor complication. One patient experienced a small amount of hemorrhagic drainage, which transitioned to serous after tranexamic acid infusion. Bariatric surgery can be performed safely with established protocols in patients who refuse blood transfusions.
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de Oliveira VL, Bestetti AM, Trasolini RP, de Moura EGH, de Moura DTH. Choosing the best endoscopic approach for post-bariatric surgical leaks and fistulas: Basic principles and recommendations. World J Gastroenterol 2023; 29:1173-1193. [PMID: 36926665 PMCID: PMC10011956 DOI: 10.3748/wjg.v29.i7.1173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/28/2022] [Accepted: 02/01/2023] [Indexed: 02/21/2023] Open
Abstract
Post-surgical leaks and fistulas are the most feared complication of bariatric surgery. They have become more common in clinical practice given the increasing number of these procedures and can be very difficult to treat. These two related conditions must be distinguished and characterized to guide the appropriate treatment. Leak is defined as a transmural defect with communication between the intra and extraluminal compartments, while fistula is defined as an abnormal communication between two epithelialized surfaces. Traditionally, surgical treatment was the preferred approach for leaks and fistulas and was associated with high morbidity with significant mortality rates. However, with the development of novel devices and techniques, endoscopic therapy plays an increasingly essential role in managing these conditions. Early diagnosis and endoscopic therapy initiation after clinical stabilization are crucial to success since clinical success rates are higher for acute leaks and fistulas when compared to late and chronic leaks and fistulas. Several endoscopic techniques are available with different mechanisms of action, including direct closure, covering/diverting or draining. The treatment should be individualized by considering the characteristics of both the patient and the defect. Although there is a lack of high-quality studies to provide standardized treatment algorithms, this narrative review aims to provide a summary of the current scientific evidence and, based on this data and our extensive experience, make recommendations to help choose the best endoscopic approach for the management of post-bariatric surgical leaks and fistulas.
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Affiliation(s)
- Victor Lira de Oliveira
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403010, Brazil
| | - Alexandre Moraes Bestetti
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403010, Brazil
| | - Roberto Paolo Trasolini
- Division of Gastroenterology, Hepatology and Endoscopy, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 021115, United States
| | - Eduardo Guimarães Hourneaux de Moura
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403010, Brazil
| | - Diogo Turiani Hourneaux de Moura
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403010, Brazil
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Aiolfi A, Gagner M, Zappa MA, Lastraioli C, Lombardo F, Panizzo V, Bonitta G, Cavalli M, Campanelli G, Bona D. Staple Line Reinforcement During Laparoscopic Sleeve Gastrectomy: Systematic Review and Network Meta-analysis of Randomized Controlled Trials. Obes Surg 2022; 32:1466-1478. [PMID: 35169954 PMCID: PMC8986671 DOI: 10.1007/s11695-022-05950-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/25/2022] [Accepted: 02/03/2022] [Indexed: 11/29/2022]
Abstract
Purpose Staple line reinforcement (SLR) during laparoscopic sleeve gastrectomy (LSG) is controversial. The purpose of this study was to perform a comprehensive evaluation of the most commonly utilized techniques for SLR. Materials and Methods Network meta-analysis of randomized controlled trials (RCTs) to compare no reinforcement (NR), suture oversewing (SR), glue reinforcement (GR), bioabsorbable staple line reinforcement (Gore® Seamguard®) (GoR), and clips reinforcement (CR). Risk Ratio (RR), weighted mean difference (WMD), and 95% credible intervals (CrI) were used as pooled effect size measures. Results Overall, 3994 patients (17 RCTs) were included. Of those, 1641 (41.1%) underwent NR, 1507 (37.7%) SR, 689 (17.2%) GR, 107 (2.7%) GoR, and 50 (1.3%) CR. SR was associated with a significantly reduced risk of bleeding (RR=0.51; 95% CrI 0.31–0.88), staple line leak (RR=0.56; 95% CrI 0.32–0.99), and overall complications (RR=0.50; 95% CrI 0.30–0.88) compared to NR while no differences were found vs. GR, GoR, and CR. Operative time was significantly longer for SR (WMD=16.2; 95% CrI 10.8–21.7), GR (WMD=15.0; 95% CrI 7.7–22.4), and GoR (WMD=15.5; 95% CrI 5.6–25.4) compared to NR. Among treatments, there were no significant differences for surgical site infection (SSI), sleeve stenosis, reoperation, hospital length of stay, and 30-day mortality. Conclusions SR seems associated with a reduced risk of bleeding, leak, and overall complications compared to NR while no differences were found vs. GR, GoR, and CR. Data regarding GoR and CR are limited while further trials reporting outcomes for these techniques are warranted. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s11695-022-05950-z.
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Affiliation(s)
- Alberto Aiolfi
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, n16, 20149, Milan, Italy.
| | | | - Marco Antonio Zappa
- UOC Chirurgia Generale Ospedale Fatebenefratelli, Asst Fatebenefratelli-Sacco Milano, Milan, Italy
| | - Caterina Lastraioli
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, n16, 20149, Milan, Italy
| | - Francesca Lombardo
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, n16, 20149, Milan, Italy
| | - Valerio Panizzo
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, n16, 20149, Milan, Italy
| | - Gianluca Bonitta
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, n16, 20149, Milan, Italy
| | - Marta Cavalli
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, n16, 20149, Milan, Italy
| | - Giampiero Campanelli
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, n16, 20149, Milan, Italy
| | - Davide Bona
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, n16, 20149, Milan, Italy
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Derebey M, Tarim IA, Mutlu V, Ozbalci AB, Ozbalci GS. Modified Omentopexy in Laparoscopic Sleeve Gastrectomy: Does It Reduce the Risk of Postoperative Complications? Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Murat Derebey
- Department of General Surgery and Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Ismail Alper Tarim
- Department of General Surgery and Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Vahit Mutlu
- Department of General Surgery and Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Aysu Basak Ozbalci
- Department of Radiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Gokhan Selcuk Ozbalci
- Department of General Surgery and Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
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Laparoscopic Sleeve Gastrectomy with Omentopexy: Is It Really a Promising Method?-A Systematic Review with Meta-analysis. Obes Surg 2021; 31:2709-2716. [PMID: 33677783 PMCID: PMC8113139 DOI: 10.1007/s11695-021-05327-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/15/2022]
Abstract
Purpose Laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed bariatric procedure worldwide. Omentopexy during LSG is a novel variation of this well-established technique. There are no clear conclusions on indications for this procedure, safeness, and effects of such a method. We aimed to compare the outcomes of laparoscopic sleeve gastrectomy (LSG) with omentopexy (OP) and without omentopexy. Materials and Methods We searched the Medline, EMBASE, and Scopus databases up-to June 2020. Full-text articles and conference abstracts were included for further analysis. This review follows the PRISMA guidelines. Results Of initial 66 records, only 4 studies (N = 1396 patients) were included in the meta-analysis. Our findings showed that LSG with omentopexy had significantly lowered overall morbidity compared to LSG without omentopexy (RR = 0.38; 95% CI [0.15, 0.94]; p=0.04). Gastric leakage rate (RR = 0.17; 95% CI [0.04, 0.76]; p = 0.02) was also significantly lower in LSG with omentopexy. There were no significant differences between groups in length of hospital stay. Conclusions Our meta-analysis showed that LSG with omentopexy may be a feasible procedure for decreasing morbidity and gastric leak rate. However, despite promising results, the procedure needs to be researched more in randomized controlled studies to draw solid conclusions. Supplementary Information The online version contains supplementary material available at 10.1007/s11695-021-05327-8.
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Simultaneous Small/Medium Umbilical Hernia Repair With Laparoscopic Sleeve Gastrectomy (LSG): Results of a Retrospective Case-matched Study. Surg Laparosc Endosc Percutan Tech 2021; 31:519-522. [PMID: 33861539 DOI: 10.1097/sle.0000000000000913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/14/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Periumbilical hernias are a common finding in morbidly obese patients undergoing bariatric surgery; however, the timing of repair is still debated. The aim of this paper is to compare the outcomes of simultaneous versus delayed mesh repair of umbilical hernia in patients undergoing laparoscopic sleeve gastrectomy (LSG). METHODS We retrospectively compared 2 groups of morbidly obese patients with small/medium periumbilical hernia (up to 4 cm) in a case-matched study: the first group underwent LSG with simultaneous periumbilical hernia repair; in the second, hernioplasty was performed after weight loss induced by LSG. Patients were matched at a 1:1 ratio according to age, comorbidities, defect size (<2 or ≥2 cm), and obesity grade (<40 or ≥40 kg/m). Demographic, clinical information, hernia size, data from the surgery, and its complications were retrieved and analyzed. RESULTS In total, 40 patients were retrieved from our prospectively maintained database and divided into 2 matched groups of 20 subjects each. Baseline characteristics were comparable. After a median time of 19.8±5.6 months, the recurrence rate was not significantly different in the 2 groups. There was no difference in the rate of single complications, but overall morbidity was significantly higher in patients undergoing a 2-step approach. LSG operation time and hospital stay resulted in comparable, but total hospital stay was longer for those readmitted for delayed hernioplasty. CONCLUSIONS In the case of morbidly obese patients with small/medium periumbilical hernia undergoing LSG, a simultaneous approach should be offered. Our proposed technique did not prolong operative time and showed a lower rate of overall morbidity.
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Chen YS, Loh EW, Shen SC, Su YH, Tam KW. Efficacy of Fibrin Sealant in Reducing Complication Risk After Bariatric Surgery: a Systematic Review and Meta-analysis. Obes Surg 2020; 31:1158-1167. [PMID: 33145716 DOI: 10.1007/s11695-020-05098-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Complications including staple-line leakage and bleeding may occur after sleeve gastrectomy and Roux-en-Y gastric bypass. In this meta-analysis, the efficacy of fibrin sealant in strengthening the staple line and reducing complication risk after bariatric surgery was evaluated. METHODS We searched PubMed, Embase, and Cochrane Library databases for randomized controlled trials (RCTs) published up to October 2020. Pooled estimates of the outcomes were computed using a random effects model. The primary outcomes were bleeding and leakage; secondary outcomes were gastric stricture, length of hospital stay, reoperation rate, and total operation time. RESULTS In total, 9 RCTs including 2136 patients were reviewed. Our meta-analysis revealed that compared with controls, fibrin sealants decreased incidence of bleeding significantly (risk ratio [RR] = 0.42; 95% confidence interval [CI], 0.18-0.97), but did not demonstrate significant differences in reducing the incidence of leakage (RR = 0.62; 95% CI, 0.23-1.73), gastric stricture (RR = 1.16; 95% CI, 0.46-2.91), reoperation rate (RR = 0.85; CI, 0.14-5.14), or length of hospital stay (weighted mean difference = 0.62; 95% CI, - 0.31 to 1.55). Compared with oversewing, fibrin sealant use reduced the operation time; however, their efficacies in reducing the incidence of postoperative bleeding and leakage did not differ significantly. CONCLUSIONS Although applying fibrin sealants to the staple line in bariatric surgery may provide favorable results, but it may not reduce postoperative leakage and stricture incidence significantly. Nevertheless, the application of fibrin sealants as a method for reducing risks of complications after bariatric surgery warrant further investigation.
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Affiliation(s)
- Yi-Shyue Chen
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - El-Wui Loh
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
| | - Shih-Chiang Shen
- Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, 291, Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan
| | - Yen-Hao Su
- Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, 291, Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan
- Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Ka-Wai Tam
- Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
- Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, 291, Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan.
- Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan.
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Efficacy of Staple Line Reinforcement With Omentopexy During Laparoscopic Sleeve Gastrectomy on Postoperative Complications: Experience of a Single Center. Surg Laparosc Endosc Percutan Tech 2020; 31:181-187. [PMID: 32941357 DOI: 10.1097/sle.0000000000000863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/14/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the protective effects of staple line reinforcement with omentopexy during laparoscopic sleeve gastrectomy on postoperative complications. MATERIALS AND METHODS A total of 3942 laparoscopic sleeve gastrectomy cases were included in the study. All the patients were divided into 3 groups: No reinforcement (NoSLR), staple line reinforcement with fibrin glue (SLR-FG), and staple line reinforcement with omentopexy (SLR-O). Demographic data and perioperative characteristics of the groups were analyzed retrospectively. Among these, age, sex, preoperative comorbidities, American Society of Anesthesiologists scores, body mass index, duration of operation, reoperation, complications, and Clavien-Dindo classification scores were recorded. RESULTS Age, sex, body mass index, comorbid diseases, American Society of Anesthesiologists, and Clavien-Dindo Classification scores were similar in all the groups. The overall complication rate was 3.0%. The overall minor and major complication rates were 1.7% and 1.3%, respectively. The mortality rate was 0.1% (4 patients). The most common postoperative complications were bleeding (0.9%) and leakage (0.5%). The incidence of leakage, bleeding, and twisted gastric sleeve rates were similar when compared between SLR-FG and NoSLR. In the SLR-O patients, the incidence of leakage, hemorrhage, and twist were significantly lower and the operation time was significantly longer when compared with the other groups. CONCLUSIONS The SLR-O technique, especially when performed by experienced surgeons, is a promising method for the prevention of postoperative leakage, bleeding, and twist complications with an acceptable increase in the duration of operation. Considering the limited effects of the SLR-FG technique, it was predicted that it would lose its popularity over time.
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The Impact of Staple Line Reinforcement Utilization on Bleeding and Leak Rates Following Sleeve Gastrectomy for Severe Obesity: a Propensity and Case-Control Matched Analysis. Obes Surg 2020; 29:2449-2463. [PMID: 30989567 DOI: 10.1007/s11695-019-03883-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Staple line reinforcement (SLR) is a commonly used technique during laparoscopic sleeve gastrectomy (SG) for severe obesity. There remains controversy over the potential benefit or risk associated with SLR. There are currently no consensus recommendations about SLR use. Its use is surgeon-dependent and remains controversial. STUDY AIM To determine the impact of staple line reinforcement on staple line leak and bleeding rates after sleeve gastrectomy. METHODS Using the Metabolic and Bariatric Surgery Quality Improvement Program Participant User File (MBSQIP-PUF) database, we identified patients who had a SG in 2015 and 2016. SLR utilization status was used to create two cohorts. An unmatched cohort analysis was performed, and the outcomes were compared. A propensity score and case-control matched cohort analysis were then performed, and the outcomes were compared. Statistical analysis was performed with SPSS and SAS. RESULTS Of the 189,173 SG cases identified, SLR utilization was noted in 127,521 (67.4%). In the unmatched analysis, bleeding and reoperation were significantly higher in the cohort without SLR utilization. In both propensity score and case-control matched analysis, bleeding and reoperation remained significantly higher in the cohort without SLR utilization. There was no difference in mortality and staple line leak rates between the cohorts. CONCLUSIONS SLR significantly reduces bleeding and reoperation rates following SG and has no deleterious impact on staple line leak rate. While further prospective studies factoring in the SLR method and staple characteristics are needed, this large database analysis supports the use of routine SLR during SG to reduce the risk of perioperative bleeding and reoperation.
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Wu C, Wang FG, Yan WM, Yan M, Song MM. Is There Necessity for Oversewing the Staple Line During Laparoscopic Sleeve Gastrectomy? An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials. J INVEST SURG 2019; 33:839-850. [PMID: 31805796 DOI: 10.1080/08941939.2019.1665380] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Laparoscopic sleeve gastrectomy (LSG) has become the current mainstream surgical treatment for obesity. With the development of clinical practice, surgeons realized the associated severity and danger of postoperative bleeding and leakage. Surgeons constantly explore different strategies to reduce the incidence of these complications. By reviewing previous clinical articles on the staple line reinforcement (SLR) in LSG, the conclusions were inconsistent regarding effectiveness. This article aims to discuss effectiveness of oversewing the staple line in LSG. Methods: From the start date of each database to September 27, 2018, a comprehensive search of published articles in English was conducted in PubMed, Embase, Central (Cochrane) databases and Scopus databases. We extracted and analyzed the main results on postoperative bleeding, staple line leakage, hospital stay and operative time of the final included articles. This review was compliant with PRISMA guidelines. Results: Finally, we extracted and analyzed 11 randomized controlled trials (RCTs) which contain 2411 patients (1219 patients as part of the oversewing (OS) group and 1192 patients in the no-oversewing (NOS) group). In the OS group, there were 15 cases (1.23%) of postoperative bleeding, and 8 cases (0.66%) of postoperative leakage. While in the NOS group, 35 patients (2.94%) had postoperative bleeding and 21 patients (1.76%) had postoperative leakage. By comparing and analyzing the OS group and the NOS group, the risk ratio (RR) for postoperative bleeding was 0.48 (95% confidence interval [CI], 0.27-0.83 p = 0.447). In addition, the RR for postoperative leakage was 0.44 (95% CI, 0.21-0.89 p = 0.835). The standardized mean difference (SMD) for hospital stay was -0.10 (95% CI, -0.25 to 0.04 p = 0.061) and 2.26 for operative time (95%CI, 0.82-3.69 p = 0.000). Conclusion: This study suggested that oversewing the staple line during LSG has a significant clinical value: it decreased the incidence of postoperative bleeding, postoperative leakage; moreover, it also significantly prolonged the operative time and but did not change hospital stay. More high-quality and large sample RCTs are expected to get more accurate results.
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Affiliation(s)
- Chang Wu
- Department of General Surgery, Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fu-Gang Wang
- Department of General Surgery, Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wen-Mao Yan
- Department of General Surgery, Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ming Yan
- Department of General Surgery, Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mao-Min Song
- Department of General Surgery, Tiantan Hospital, Capital Medical University, Beijing, China
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Pilone V, Tramontano S, Renzulli M, Romano M, Monda A, Albanese A, Foletto M. Omentopexy with Glubran®2 for reducing complications after laparoscopic sleeve gastrectomy: results of a randomized controlled study. BMC Surg 2019; 19:56. [PMID: 31690312 PMCID: PMC6829794 DOI: 10.1186/s12893-019-0507-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 04/09/2019] [Indexed: 01/12/2023] Open
Abstract
Background Gastric fistulas, bleeding, and strictures are commonly reported after laparoscopic sleeve gastrectomy (LSG), that increase morbidity and hospital stay and may put the patient’s life at risk. We report our prospective evaluation of application of synthetic sealant, a modified cyanoacrylate (Glubran®2), on suture rime, associated with omentopexy, to identify results on LSG-related complications. Methods Patients were enrolled for LSG by two Bariatric Centers, with high-level activity volume. Intraoperative recorded parameters were: operative time, estimated intraoperative bleeding, conversion rate. We prospectively evaluated the presence of early complications after LSG during the follow up period. Overall complications were analyzed. Perioperative data and weight loss were also evaluated. A control group was identified for the study. Results Group A (treated with omentopexy with Glubran®2) included 96 cases. Control group included 90 consecutive patients. There were no differences among group in terms of age, sex and Body Mass Index (BMI). No patient was lost to follow-up for both groups. Overall complication rate was significantly reduced in Group A. Mean operative time and estimated bleeding did not differ from control group. We observed three postoperative leaks in Group B, while no case in Group A (not statistical significancy). We did not observe any mortality, neither reoperation. Weight loss of the cohort was similar among groups. In our series, no leaks occurred applying omentopexy with Glubran®2. Conclusion Our experience of omentopexy with a modified cyanoacrylate sealant may lead to a standardized and reproducible approach that can be safeguard for long LSG-suture rime. Trial registration Retrospective registration on clinicaltrials.gov PRS, with TRN NCT03833232 (14/02/2019).
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Affiliation(s)
- Vincenzo Pilone
- General, Bariatric and Emergency Surgery Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy
| | - Salvatore Tramontano
- General, Bariatric and Emergency Surgery Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy.
| | - Michele Renzulli
- General, Bariatric and Emergency Surgery Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy
| | - Mafalda Romano
- General, Bariatric and Emergency Surgery Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy
| | - Angela Monda
- General, Bariatric and Emergency Surgery Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy
| | - Alice Albanese
- Week Surgery Unit, University Hospital of Padova, Padova, Italy
| | - Mirto Foletto
- Week Surgery Unit, University Hospital of Padova, Padova, Italy
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Ozdenkaya Y, Olmuscelik O, Basim P, Saka B, Arslan NC. The effect of fibrin glue in preventing staple-line leak after sleeve gastrectomy. An experimental study in rats. Acta Cir Bras 2019; 34:e201900801. [PMID: 31618401 PMCID: PMC6802941 DOI: 10.1590/s0102-865020190080000001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 07/08/2019] [Indexed: 01/18/2023] Open
Abstract
Purpose To evaluate the effect of fibrin glue on staple-line leak after sleeve
gastrectomy. Methods Fourteen adult wistar rats 300 gr were randomized into two groups: Control
group (n=7) and study group (n=7). All the rats underwent sleeve gastrectomy
using lineer stapler. In the study group, fibrin glue was used to reinforce
the staple-line. The rats were sacrificed 7 days after surgery. The stomach
was resected, submerged in saline and exposed to excess pressure to obtain a
burst pressure value. The gastric staple line was evaluated
histopathologically according to the Ehrlich Hunt scale. The results of the
two groups were compared. Results The mean Ehrlich-Hunt scores for inflammation, fibroblastic activity and
neo-angiogenesis were similar between the groups (p>0.05). Collagen
deposition was significantly higher in study group (3.42±0.53) when compared
with control group (2.57±0.78) (p=0.035). The mean burst pressure was
137.8±8.5 mmHg for control group and 135.0±8.1 mmHg for study group
(p=0.536). Conclusion Reinforcement of the staple-line with fibrin glue has no effect on the burst
pressure after sleeve gastrectomy. More studies are needed to evaluate the
precautions against leak after sleeve gastrectomy.
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Affiliation(s)
- Yasar Ozdenkaya
- MD, Assistant Professor, Department of General Surgery , Medipol University Medical Faculty , Istanbul , Turkey . Conception and design of the study, acquisition of data, manuscript writing
| | - Oktay Olmuscelik
- MD, Assistant Professor, Department of Internal Medicine , Medipol University Medical Faculty, Istanbul , Turkey . Conception of the study, acquisition of data, critical revision
| | - Pelin Basim
- MD, Assistant Professor, Department of General Surgery , Medipol University Medical Faculty , Istanbul , Turkey . Conception and design of the study, acquisition of data, critical revision
| | - Burcu Saka
- MD, Assistant Professor, Department of Pathology , Medipol University Medical Faculty , Istanbul , Turkey . Histopathological examinations
| | - Naciye Cigdem Arslan
- MD, Associate Professor, Department of General Surgery , Medipol University Medical Faculty , Istanbul , Turkey . Statistics analysis, manuscript writing, final approval
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13
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Gagner M, Kemmeter P. Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review. Surg Endosc 2019; 34:396-407. [PMID: 30993513 PMCID: PMC6946737 DOI: 10.1007/s00464-019-06782-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/04/2019] [Indexed: 12/19/2022]
Abstract
Background Staple-line leaks following laparoscopic sleeve gastrectomy (LSG) remain a concerning complication. Staple-line buttressing is largely adopted as an acceptable reinforcement but data regarding leaks have been equivocal. This study compared staple-line leaks in five reinforcement options during LSG: no reinforcement (NO-SLR), oversewing (suture), nonabsorbable bovine pericardial strips (BPS), tissue sealant or fibrin glue (Seal), or absorbable polymer membrane (APM). Methods This systematic review study of articles published between 2012 and 2016 regarding LSG leak rates aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Variables of interest included leak rates, bleeding, and complications in addition to surgical and population parameters. An independent Fisher’s exact test was used to compare the number of patients with and without leaks for the different reinforcement options. Results Of the 1633 articles identified, 148 met inclusion criteria and represented 40,653 patients. Differences in age (older in APM; p = 0.001), starting body mass index (lower in Suture; p = 0.008), and distance from pylorus (closer in BPS; p = 0.04) were observed between groups, but mean bougie size was equivalent. The overall leak rate of 1.5% (607 leaks) ranged from 0.7% for APM (significantly lower than all groups; p ≤ 0.007 for next lowest leak rate) to 2.7% (BPS). Conclusions This systematic review of staple-line leaks following LSG demonstrated a significantly lower rate using APM staple-line reinforcement as compared to oversewing, use of sealants, BPS reinforcement, or no reinforcement. Variation in surgical technique may also contribute to leak rates. Electronic supplementary material The online version of this article (10.1007/s00464-019-06782-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michel Gagner
- Department of Surgery, Hopital du Sacré Coeur, 315 Place D’Youville, Suite 191, Montréal, QC H2Y 0A4 Canada
- Herbert Wertheim School of Medicine, Florida International University, Miami, FL USA
- Westmount Square Surgical Center, Westmount, QC Canada
| | - Paul Kemmeter
- Department of Surgery, Mercy Health Saint Mary’s, 2060 E Paris Ave SE #100, Grand Rapids, MI USA
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14
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Zafar SN, Felton J, Miller K, Wise ES, Kligman M. Staple Line Treatment and Bleeding After Laparoscopic Sleeve Gastrectomy. JSLS 2019; 22:JSLS.2018.00056. [PMID: 30607100 PMCID: PMC6305063 DOI: 10.4293/jsls.2018.00056] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background and Objectives: 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 (POB) among various methods of staple line reinforcement. Methods: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program 2015 dataset was queried for patients undergoing an LSG. 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 was POB. Multivariable logistic regression was used to compare POB rates among the treatment groups. Results: In the 98,142 LSG patients meeting selection criteria, 623 (0.63%) patients had POB and 181 (0.18%) required reoperation. POB occurred in 0.80% for the NT group, 0.68% for the OVERSEW group, 0.57% for the BUTTRESS group, and 0.55% for the COMBINATION group. On multivariable analyses, all treatment groups were less likely to have POB compared with the NT group—OVERSEW (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.54–0.98), BUTTRESS (OR 0.70, 95% CI 0.57–0.84), and COMBINATION (OR 0.66, 95% CI 0.50–0.89) (all P < .01). Subset analysis revealed no difference between BUTTRESS and OVERSEW (OR 0.95, 95% CI 0.71–1.26, P = .71). Conclusions: Relative to an NT staple line, the use of OVERSEW or BUTTRESS can decrease the rates of POB by up to 30%. The use of these techniques should be strongly considered by the bariatric surgeon.
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Affiliation(s)
- Syed Nabeel Zafar
- Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Jessica Felton
- Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Kaylie Miller
- School of Medicine, University of Maryland, Baltimore, Maryland
| | - Eric S Wise
- Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Mark Kligman
- Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland
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15
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Milone M, Manigrasso M, Burati M, Elmore U, Gennarelli N, Cesare Giglio M, Maione F, Musella M, Lo Conte V, Milone F, Domenico De Palma G. Intracorporeal versus extracorporeal anastomosis after laparoscopic gastrectomy for gastric cancer. A systematic review with meta-analysis. J Visc Surg 2019; 156:305-318. [PMID: 30737053 DOI: 10.1016/j.jviscsurg.2019.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIM To perform a systematic review and meta-analyses of studies comparing the totally laparoscopic procedures with intracorporeal anastomosis (IA) to laparoscopic-assisted surgery with extracorporeal anastomosis (EA) in gastric resections. METHODS We performed a systematic search in the electronic databases. Outcomes analysed were: intraoperative (operative time and intraoperative blood loss), oncologic (harvested nodes, distance of the tumour from proximal and distal margin), postoperative complications (gastric stasis, intraluminal and extraluminal bleeding, leakage and wound infection) recovery (time to first flatus, time to first oral intake and hospital stay). We performed meta-regression analyses after implementing a regression model with the analysed outcomes as dependent variables (y) and the demographic and pathologic covariates as independent variables (x). RESULTS A total of 26 studies (20 on distal gastrectomy and 6 on total gastrectomy) were included in the final analysis. Regarding distal gastrectomy, there was no statistical difference between the two groups in the above-mentioned outcomes, except for intraoperative blood loss (less in IA group, P=0.003), number of harvested nodes (better in the IA group, P=0.022) and length of hospital stay (shorter in the IA group, P=0.037). Regarding total gastrectomy, there was no statistical difference for all outcomes, except for the distal margin (further in the EA group, P=0.040). Meta-regression analysis showed that a lot of variables influenced results in distal gastric resections, but not in total gastric resections. CONCLUSION We can state laparoscopic gastric resections with IA are safe and feasible when performed by expert surgeons. However, new well-designed studies comparing the two techniques are needed to confirm the benefits of laparoscopic IA.
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Affiliation(s)
- M Milone
- Department of General and Specialistic Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - M Manigrasso
- Department of General and Specialistic Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - M Burati
- Department of General and Specialistic Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - U Elmore
- Department of Gastrointestinal surgery, Vita Salute University, San Raffaele Scientific Institute, Via Olgettina Milano 58, 20132, Milan, Italy
| | - N Gennarelli
- Department of Surgery and Advanced Technologies, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - M Cesare Giglio
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - F Maione
- Department of Surgery and Advanced Technologies, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - M Musella
- Department of General and Specialistic Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - V Lo Conte
- Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - F Milone
- Department of General and Specialistic Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - G Domenico De Palma
- Department of Surgery and Advanced Technologies, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
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16
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Velotti N, Manigrasso M, Di Lauro K, Vitiello A, Berardi G, Manzolillo D, Anoldo P, Bocchetti A, Milone F, Milone M, De Palma GD, Musella M. Comparison between LigaSure™ and Harmonic® in Laparoscopic Sleeve Gastrectomy: A Single-Center Experience on 422 Patients. J Obes 2019; 2019:3402137. [PMID: 30719344 PMCID: PMC6335858 DOI: 10.1155/2019/3402137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/26/2018] [Accepted: 12/09/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND New laparoscopic devices, such as electrothermal bipolar-activated devices (LigaSure™ (LS)) or ultrasonic systems (Harmonic® scalpel (HS)), have been applied recently to bariatric surgery allowing to reduce blood loss and surgical risks. The aim of this study was to retrospectively compare intraoperative performance of HS and LS, postoperative results, and clinical outcomes in a large cohort of patients undergoing LSG. METHODS Data from 422 morbidly obese patients undergoing LSG in our Bariatric Unit at the Advanced Biomedical Sciences Department of the "Federico II" University of Naples (Italy) between January 2009 and December 2017 were retrospectively analyzed. Subjects were divided into two groups (HS and LS), and operative time, intraoperative complications, and postoperative (within 30 days from surgery) complications were compared. Bleeding from the omentum or from the staple line, use of hemostatic clips, and absorbable hemostat were recorded as intraoperative complications; hemorrhages, abscess formation, gastric leaks, fever, and mortality were considered as postoperative complications. RESULTS Statistical analysis showed no difference in terms of baseline demographics between the two cohorts. Operative time (48 ± 9 vs 49 ± 6 min, p=0.646) and the rates of intraoperative and postoperative complications did not significantly differ between groups. CONCLUSION Harmonic® and LigaSure™ are both useful tools in bariatric surgery, and these two advanced power devices are user-friendly and can facilitate surgeon work; from this point of view, the choice of the energy device should be based on the preference of the surgeon and on the hospital costs policy and availability.
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Affiliation(s)
- N. Velotti
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - M. Manigrasso
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - K. Di Lauro
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - A. Vitiello
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - G. Berardi
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - D. Manzolillo
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - P. Anoldo
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - A. Bocchetti
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - F. Milone
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - M. Milone
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - G. D. De Palma
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - M. Musella
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
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17
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Zhang X, Zhang L, Yu Y, Sun S, Sun T, Sun Y. Human fibrin sealant reduces post-operative bile leakage of primary closure after laparoscopic common bile duct exploration in patients with choledocholithiasis. J Minim Access Surg 2019; 15:320-324. [PMID: 29974875 PMCID: PMC6839356 DOI: 10.4103/jmas.jmas_129_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Context: Primary closure of the common bile duct (CBD) without drainage is considered a suitable approach after laparoscopic CBD exploration (LCBDE); however, the risk of post-operative bile leakage is high. Up to now, it has not been clear whether human fibrin sealant can reduce post-operative bile leakage of the primary suture. Aims: In this study, we evaluated the role of human fibrin sealant in primary closure of the CBD after LCBDE. Subjects and Methods: Patients with choledocholithiasis who had undergone primary duct closure of the CBD after LCBDE were divided into two groups according to whether fibrin sealant was used. Statistical Analysis Used: Fisher's exact test or the Chi-square test was used for categorical variables to calculate frequencies and percentages between the groups. The Student's t-test was used to compare the means of the continuous variables between the groups. Results: The human fibrin sealant group had a lower rate of post-operative bile leakage compared to the other group (P < 0.05). There were no significant differences in additional parameters such as operative time, post-operative stay duration, time to drain removal, bile duct stenosis, acute allergic reaction and overall mortality. Conclusions: Human fibrin sealant can reduce post-operative bile leakage in primary closure of CBD after LCBDE in patients with choledocholithiasis.
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Affiliation(s)
- Xu Zhang
- Department of General Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Lei Zhang
- Department of General Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Yang Yu
- Department of General Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Shibo Sun
- Department of General Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Tiewei Sun
- Department of General Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Yan Sun
- Department of General Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
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18
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Laparoscopic Sleeve Gastrectomy has a Lower Risk of Postoperative Bleeding Than Laparoscopic Roux-en-Y Gastric Bypass. Surg Laparosc Endosc Percutan Tech 2018; 29:53-57. [PMID: 30499889 DOI: 10.1097/sle.0000000000000598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Measures to reduce postoperative bleeding (POB) after bariatric surgery is skewed toward laparoscopic sleeve gastrectomy (LSG). We use 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) to characterize the differences in bleeding rates between LSG and laparoscopic Roux-en-Y gastric bypasses (LRYGB). Propensity score matching and multivariable logistic regressions tested for independent differences in POB rates. A total of 168,093 patients from 742 centers were identified in the data set. After selection 36,925 patients with LRYGB and 20,020 patients with LSG were included in the analysis. A total of 710 (1.25%) patient suffered a POB. The independent odds of POB were 38% lower for patients having LSG compared with those having LRYGB (odds ratio, 0.62; 95% confidence interval=0.51-0.76). This difference is more pronounced with intraoperative securing of the staple line. Appropriate measures to reduce POB after each type of bariatric procedure is warranted.
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19
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Effectiveness of Fibrin Sealant Application on the Development of Staple Line Complications After Sleeve Gastrectomy: A Prospective Randomized Trial. Ann Surg 2018; 268:762-768. [PMID: 30080735 DOI: 10.1097/sla.0000000000002892] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Evaluate the effectiveness of the use of fibrin sealant (FS) for preventing the development of staple line complications (SLCs) after sleeve gastrectomy (SG). BACKGROUND There is no consensus on the best means of preventing SLCs after SG. METHODS This was a prospective, intention-to-treat, randomized, 2 center study of a group of 586 patients undergoing primary SG (ClinicalTrials.gov identifier: NCT01613664) between March 2014 and June 2017. The 1:1 randomization was stratified by center, age, sex, gender, and body mass index, giving 293 patients in the FS group and 293 in the control group (without FS). The primary endpoint (composite criteria) was the incidence of SLCs in each of the 2 groups. The secondary criteria were the mortality rate, morbidity rate, reoperation rate, length of hospital stay, readmission rate, and risk factors for SLC. RESULTS There were no intergroup differences in demographic variables. In an intention-to-treat analysis, the incidence of SLCs was similar in the FS and control groups (1.3% vs 2%, respectively; P = 0.52). All secondary endpoints were similar: complication rate (5.4% vs 5.1%, respectively; P = 0.85), mortality rate (0.3% vs 0%, respectively; P = 0.99), GL rate (0.3% vs 1.3%, respectively; P = 0.18), postoperative hemorrhage/hematoma rate (1% vs 0.7%, respectively; P = 0.68), reoperation rate (1% vs 0.3%, respectively; P = 0.32). Length of stay was 1 day in both groups (P = 0.89), and the readmission rate was similar (5.1% vs 3.4%, respectively; P = 0.32). No risk factors for SLCs were found. CONCLUSION The incidence of postoperative SLCs did not appear to depend on the presence or absence of FS.
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20
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Musella M, Di Capua F, D’Armiento M, Velotti N, Bocchetti A, Di Lauro K, Galloro G, Campione S, Petrella G, D’Armiento FP. No Difference in Ghrelin-Producing Cell Expression in Obese Versus Non-obese Stomach: a Prospective Histopathological Case-Control Study. Obes Surg 2018; 28:3604-3610. [DOI: 10.1007/s11695-018-3401-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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21
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Bianco P, Rizzuto A, Velotti N, Bocchetti A, Manzolillo D, Maietta P, Milone M, Amato M, Conzo G, Buonomo O, Petrella G, Musella M. Results following laparoscopic sleeve gastrectomy in elderly obese patients: a single center experience with follow-up at three years. MINERVA CHIR 2018; 75:77-82. [PMID: 29963791 DOI: 10.23736/s0026-4733.18.07757-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) represents the most performed bariatric surgical procedure worldwide. Morbid Overweight in elderly patients is becoming a significant health problem even in Italy. As well as in younger age groups, bariatric surgery could be indicated even in this subset of patients. However the advantages and results of LSG in patients over 60 years old have received minimal attention. METHODS The records of 375 patients underwent LSG between 2008 and 2016 were reviewed. In the entire series 18 patients were aged 60 years or older at the time of surgery. Since a 3 years follow-up was available for 12 patients out of the 18 aged over 60 we included in the study only these. General epidemiologic data, clinical findings, BMI and comorbidities surgical treatment and follow-up data were collected; postoperative measurements such as operative time, intraoperative complications, mortality rate, length of stay, incidence of early and late complications, Body mass Index (BMI), excess weight loss rate (EWL%) and comorbidities resolution were also recorded. RESULTS LSG was successfully performed for all geriatric patients. Global complications rate was 16.6% At 3 years mean BMI was 34.4±3.8 with a mean EWL% 66.1±31.9. Postoperative resolution of obesity comorbidities was observed; Hypertension (71.4%), type 2 Diabetes Mellitus (T2DM) (50.0%), obstructive sleep apnea syndrome (OSAS) (66.6%) respectively. No intraoperative complications or mortality were recorded. CONCLUSIONS LSG offered cure in geriatric patients affected by morbid obesity for weight loss and comorbidities resolution. Larger studies are necessary to analyze and minimize the incidence of postoperative complications associated to this surgical procedure in elderly patients.
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Affiliation(s)
- Paolo Bianco
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Antonia Rizzuto
- Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | - Nunzio Velotti
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Alessio Bocchetti
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Domenico Manzolillo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Paola Maietta
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Marco Milone
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Maurizio Amato
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Giovanni Conzo
- Department of Cardiothoracic and Respiratory Sciences, Luigi Vanvitelli University, Naples, Italy
| | - Oreste Buonomo
- Department of Surgery, Tor Vergata University, Rome, Italy
| | | | - Mario Musella
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy -
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22
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Velotti N, Bianco P, Bocchetti A, Milone M, Manzolillo D, Maietta P, Amato M, Buonomo O, Petrella G, Musella M. Acute complications following endoscopic intragastric balloon insertion for treatment of morbid obesity in elderly patients. A single center experience. MINERVA CHIR 2018; 75:72-76. [PMID: 29658677 DOI: 10.23736/s0026-4733.18.07712-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Obesity is a serious disease, with an increasing incidence also among subjects over 60 years old; surgical management has proven to be the most effective in the production of significant and durable weight loss. Intragastric balloon (IGB) treatment promotes a reduction of five to nine Body Mass Index (BMI) units in 6 months with an impressive improvement of obesity-associated comorbidities. METHODS Two hundred and twenty-five patients, 106 men (47.1%) and 119 women (52.9%), were evaluated at our institution to be submitted to a IGB positioning. Of these, 12 patients (8 women and 4 men) were more than 60 years old. For all patients BMI, comorbidities, weight loss and complications were recorded. χ2 test was used to evaluate differences in complications rate between elderly and other patients. RESULTS For the 12 elderly patients, we recorded a mean excess weight loss rate (EWL%) of 31.4. About complications, we recorded 2 severe esophagitis requiring IGB removal and 1 late gastric perforation. A higher complications rate was found in elderly population and the comparison with other patients revealed a significant difference (P<0.001). CONCLUSIONS Our results underline that IGB treatment in elderly patients is safe and effective in terms of weight loss and improvement in comorbidities. IGB can cause complications which, sometimes, can be severe such as esophageal damage and gastric perforation. For the management of complications, we highly recommend a close follow-up in all patients and a deepened instrumental study in every suspect case.
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Affiliation(s)
- Nunzio Velotti
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy -
| | - Paolo Bianco
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Alessio Bocchetti
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Marco Milone
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Domenico Manzolillo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Paola Maietta
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Maurizio Amato
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Oreste Buonomo
- Department of Surgery, Tor Vergata University, Rome, Italy
| | | | - Mario Musella
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
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23
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Edwards SJ, Crawford F, van Velthoven MH, Berardi A, Osei-Assibey G, Bacelar M, Salih F, Wakefield V. The use of fibrin sealant during non-emergency surgery: a systematic review of evidence of benefits and harms. Health Technol Assess 2018; 20:1-224. [PMID: 28051764 DOI: 10.3310/hta20940] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Fibrin sealants are used in different types of surgery to prevent the accumulation of post-operative fluid (seroma) or blood (haematoma) or to arrest haemorrhage (bleeding). However, there is uncertainty around the benefits and harms of fibrin sealant use. OBJECTIVES To systematically review the evidence on the benefits and harms of fibrin sealants in non-emergency surgery in adults. DATA SOURCES Electronic databases [MEDLINE, EMBASE and The Cochrane Library (including the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, the Health Technology Assessment database and the Cochrane Central Register of Controlled Trials)] were searched from inception to May 2015. The websites of regulatory bodies (the Medicines and Healthcare products Regulatory Agency, the European Medicines Agency and the Food and Drug Administration) were also searched to identify evidence of harms. REVIEW METHODS This review included randomised controlled trials (RCTs) and observational studies using any type of fibrin sealant compared with standard care in non-emergency surgery in adults. The primary outcome was risk of developing seroma and haematoma. Only RCTs were used to inform clinical effectiveness and both RCTs and observational studies were used for the assessment of harms related to the use of fibrin sealant. Two reviewers independently screened all titles and abstracts to identify potentially relevant studies. Data extraction was undertaken by one reviewer and validated by a second. The quality of included studies was assessed independently by two reviewers using the Cochrane Collaboration risk-of-bias tool for RCTs and the Centre for Reviews and Dissemination guidance for adverse events for observational studies. A fixed-effects model was used for meta-analysis. RESULTS We included 186 RCTs and eight observational studies across 14 surgical specialties and five reports from the regulatory bodies. Most RCTs were judged to be at an unclear risk of bias. Adverse events were inappropriately reported in observational studies. Meta-analysis across non-emergency surgical specialties did not show a statistically significant difference in the risk of seroma for fibrin sealants versus standard care in 32 RCTs analysed [n = 3472, odds ratio (OR) 0.84, 95% confidence interval (CI) 0.68 to 1.04; p = 0.13; I2 = 12.7%], but a statistically significant benefit was found on haematoma development in 24 RCTs (n = 2403, OR 0.62, 95% CI 0.44 to 0.86; p = 0.01; I2 = 0%). Adverse events related to fibrin sealant use were reported in 10 RCTs and eight observational studies across surgical specialties, and 22 RCTs explicitly stated that there were no adverse events. One RCT reported a single death but no other study reported mortality or any serious adverse events. Five regulatory body reports noted death from air emboli associated with fibrin sprays. LIMITATIONS It was not possible to provide a detailed evaluation of individual RCTs in their specific contexts because of the limited resources that were available for this research. In addition, the number of RCTs that were identified made it impractical to conduct independent data extraction by two reviewers in the time available. CONCLUSIONS The effectiveness of fibrin sealants does not appear to vary according to surgical procedures with regard to reducing the risk of seroma or haematoma. Surgeons should note the potential risk of gas embolism if spray application of fibrin sealants is used and not to exceed the recommended pressure and spraying distance. Future research should be carried out in surgery specialties for which only limited data were found, including neurological, gynaecological, oral and maxillofacial, urology, colorectal and orthopaedics surgery (for any outcome); breast surgery and upper gastrointestinal (development of haematoma); and cardiothoracic heart or lung surgery (reoperation rates). In addition, studies need to use adequate sample sizes, to blind participants and outcome assessors, and to follow reporting guidelines. STUDY REGISTRATION This study is registered as PROSPERO CRD42015020710. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Milone M, Velotti N, Musella M. Wernicke Encephalopathy Following Laparoscopic Sleeve Gastrectomy—a Call to Evaluate Thiamine Deficiencies After Restrictive Bariatric Procedures. Obes Surg 2018; 28:852-853. [PMID: 29307105 DOI: 10.1007/s11695-017-3083-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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25
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Docimo S, Svestka M. Endoscopic Evaluation and Treatment of Postoperative Bariatric Surgery Complications. Surg Innov 2017; 24:616-624. [PMID: 29072533 DOI: 10.1177/1553350617736651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The number of patients undergoing bariatric surgery continues to increase. The American Society for Metabolic and Bariatric Surgery (ASMBS) estimates the number of bariatric surgical procedures performed increased from 158 000 in 2011 to 190 000 in 2015. Concurrently, the incidence of postoperative complications specific to bariatric patients will inevitably increase as well. Endoscopic evaluation of postoperative bariatric patients and endoscopic interventions are rapidly evolving. We present a review of the postoperative anatomy of bariatric patients, what complications to expect, and treatment options.
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Karaman K, Aziret M, Ercan M, Ebiloglu T, Karadeniz U, Bostanci EB. A Preventive Strategy for Staple Line Bleeding in Morbidly Obese Patients Undergoing Sleeve Gastrectomy. J Laparoendosc Adv Surg Tech A 2017; 27:1015-1021. [PMID: 28829225 DOI: 10.1089/lap.2017.0386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Risk factors for staple line bleeding (SLB) during and after sleeve gastrectomy (SG) are various, including patient related factors, perioperative medications, and surgical technique, although there is little clarification in the literature of the role played by blood pressure during the stapling phase. The aim of the present retrospective cohort study was to identify possible risk factors liable to cause SLB. MATERIALS AND METHODS Data collected prospectively from 120 consecutive patients who underwent SG were analyzed retrospectively according to age, gender, body mass index (BMI), international normalized ratio (INR) value, intraoperative systolic blood pressure (SBP), and mean arterial blood pressure (MABP). RESULTS In univariate analysis, age, stapling phase SBP and MABP, and the duration of surgery were all significantly higher in patients with SLB than those without (P < .05). In distinguishing patients with SLB from those without, the cutoff threshold for SBP during the stapling phase was 120 mmHg with a 78.9% sensitivity, 97.6% specificity, 93.8% positive predictive value, 90.9% negative predictive value, and 91.7% accuracy (AUC = 0.908, 95% CI: 0.839-0.976, and P < .001). In multivariate logistic regression analysis, independent of age and operation time, SBP >120 mmHg significantly maintained its predictive power on SLB (95% CI: 32.410-1457.896, P < .001). CONCLUSION A SBP >120 mmHg during the division of the stomach is an independent risk factor for SLB. Maintaining intraoperative SBP ≤120 mmHg during the stapling phase does not only decrease the risk of SLB but also the need for homeostatic agents such as clips and sutures, which in turn prolong the operative time and increase cost.
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Affiliation(s)
- Kerem Karaman
- 1 Department of Gastroenterological Surgery, Sakarya University Teaching and Research Hospital , Sakarya, Turkey
| | - Mehmet Aziret
- 1 Department of Gastroenterological Surgery, Sakarya University Teaching and Research Hospital , Sakarya, Turkey
| | - Metin Ercan
- 1 Department of Gastroenterological Surgery, Sakarya University Teaching and Research Hospital , Sakarya, Turkey
| | - Tugce Ebiloglu
- 2 Department of Anesthesiology, Sakarya University Teaching and Research Hospital , Sakarya, Turkey
| | - Umit Karadeniz
- 2 Department of Anesthesiology, Sakarya University Teaching and Research Hospital , Sakarya, Turkey
| | - Erdal Birol Bostanci
- 1 Department of Gastroenterological Surgery, Sakarya University Teaching and Research Hospital , Sakarya, Turkey
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Taha O, Abdelaal M, Talaat M, Abozeid M. A Randomized Comparison Between Staple-Line Oversewing Versus No Reinforcement During Laparoscopic Vertical Sleeve Gastrectomy. Obes Surg 2017; 28:218-225. [DOI: 10.1007/s11695-017-2835-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Musella M, Milone M, Bianco P, Milone F. The visualization of gastro-esophageal junction vascular supply during a laparoscopic sleeve gastrectomy. Role of a new device. Updates Surg 2017; 69:541-544. [PMID: 28681283 DOI: 10.1007/s13304-017-0479-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 06/24/2017] [Indexed: 11/24/2022]
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Guetta O, Ovnat A, Czeiger D, Vakhrushev A, Tsaban G, Sebbag G. The Impact of Technical Surgical Aspects on Morbidity of 984 Patients after Sleeve Gastrectomy for Morbid Obesity. Obes Surg 2017; 27:2785-2791. [DOI: 10.1007/s11695-017-2721-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Varban OA, Sheetz KH, Cassidy RB, Stricklen A, Carlin AM, Dimick JB, Finks JF. Evaluating the effect of operative technique on leaks after laparoscopic sleeve gastrectomy: a case-control study. Surg Obes Relat Dis 2016; 13:560-567. [PMID: 28089439 DOI: 10.1016/j.soard.2016.11.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/10/2016] [Accepted: 11/29/2016] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To assess the effect of operative technique on staple line leaks after laparoscopic sleeve gastrectomy (LSG). BACKGROUND Staple-line leaks after LSG are a major source of morbidity and mortality. Variations in operative technique exist; however, their effect on leaks is poorly understood. METHODS We analyzed data from the Michigan Bariatric Surgery Collaborative (MBSC) to perform a case-control study comparing patients who had a clinically significant leak after undergoing a primary LSG to those who did not. A total of 45 patients with leaks were identified between January 2007 and December 2013. The leak group was matched 1:2 to a control group based on procedure type, age, body mass index, sex, and year the procedure was performed. Technique-specific factors were assessed by reviewing operative notes from all primary bariatric procedures in our study population. Conditional logistic regression was used to identify techniques associated with leaks. To increase the power of our analysis, we used a significance level of .10. RESULTS Leak rates with LSG have decreased over the past 5 years (1.18% to .36%) as annual case volume has increased (846 cases/yr to 4435 cases/yr). Surgeons who performed 43 or more cases per year had a leak rate<1%. Leaks were more common among cases requiring a blood transfusion (26.2% versus 1.08%, P = .0031) and when cases were converted to open surgery (7.14% versus 0%, P = .0741). However, there was no significant difference in operative time between cases involving a leak and their matched controls (95.4 min versus 87.1 min, P = .1197). Oversewing of the staple line was the only technique associated with less leaks after controlling for confounding factors (OR .397 CI .174, .909, P = .0665). Notably, surgeons who oversewed routinely were also found to have higher case volume (307 versus 140, P = .0216) and less overall complication rates (4.81% versus 7.95%, P = .0027). Furthermore, oversewing technique varied widely as only 22.6% of cases involved oversewing of the entire staple line. CONCLUSION Despite considerable variation in operative technique, leak rates with laparoscopic sleeve gastrectomy have decreased over time as operative volume has increased. Oversewing of the staple line was associated with fewer leaks, but specific suturing technique was not uniform and oversewing was performed routinely by more experienced surgeons with higher case volumes and less complication rates overall. Before standardizing surgical technique one must take into account variations in surgeon skill and experience.
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Affiliation(s)
- Oliver A Varban
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, Michigan.
| | - Kyle H Sheetz
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, Michigan
| | - Ruth B Cassidy
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Amanda Stricklen
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Arthur M Carlin
- Wayne State University, Detroit, Michigan; Department of Surgery, Henry Ford Health System, Dearborn, Michigan
| | - Justin B Dimick
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Jonathan F Finks
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, Michigan
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Coskun H, Yardimci E. Effects and results of fibrin sealant use in 1000 laparoscopic sleeve gastrectomy cases. Surg Endosc 2016; 31:2174-2179. [PMID: 27604365 DOI: 10.1007/s00464-016-5215-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 08/23/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Staple-line leakage and bleeding are worrisome and feared postoperative complications after laparoscopic sleeve gastrectomy (LSG) in morbidly obese patients. The purpose of this study was to review clinical evidence following the use of fibrin sealant in standard LSG. METHODS Morbidly obese patients who underwent standard technique of LSG with using fibrin sealant were included in the study. Demographics variables [age, gender, body mass index (kg/m2), and comorbid conditions], the re-admission rate, and postoperative early complications, such as bleeding, staple-line leak, twist and stricture, were evaluated at the follow-up during the postoperative first month. RESULTS In total, 1000 patients [586 female (58.6 %)] with a mean age of 42.6 ± 13.6 years underwent LSG. Fibrin sealant was used in all operations. In total, 186 patients (18.6 %) had previous abdominal surgery. The mean operative time was 72 ± 19 min, and the mean hospital stay was 3.2 ± 1.1 days. Only 3 patients (.3 %) experienced bleeding. Staple-line leakage, twist and stricture were not observed. The re-admission rate was .5 %, and no mortalities were noted. CONCLUSION This retrospective study indicates that bariatric surgeons should consider implementing standardized surgical operative technique for reduced postoperative complications in LSG. Fibrin sealant is a reliable and useful tool to reinforce the staple line and may prevent potential twists of the sleeved stomach.
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Affiliation(s)
- Halil Coskun
- Department of General Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Erkan Yardimci
- Department of General Surgery, Bezmialem Vakif University, Istanbul, Turkey. .,Department of General Surgery, Arnavutkoy State Hospital, Eski Edirne Str, Arvanutkoy, 34275, Istanbul, Turkey.
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Wentzell J, Neff M. The weight is over: RN first assisting techniques for laparoscopic sleeve gastrectomy. AORN J 2016; 102:161-80. [PMID: 26227520 DOI: 10.1016/j.aorn.2015.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 02/08/2015] [Accepted: 05/21/2015] [Indexed: 11/20/2022]
Abstract
Obesity-related laparoscopic sleeve gastrectomy is a common yet technically challenging bariatric procedure that requires specialized surgical knowledge and training for OR personnel. Critical components of care include an effective preoperative assessment, positioning of the patient, and operation and maintenance of laparoscopic equipment and instrumentation. The purpose of this article is to explain the steps of laparoscopic sleeve gastrectomy and illustrate principles and surgical techniques for the RN who is first assisting during the procedure. Also provided is a perioperative nursing care plan for the patient undergoing bariatric surgery, to aid perioperative nurses in understanding the sequence of events and special considerations for this patient population.
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Musella M, Milone M, Bianco P, Maietta P, Galloro G. Acute Leaks Following Laparoscopic Sleeve Gastrectomy: Early Surgical Repair According to a Management Algorithm. J Laparoendosc Adv Surg Tech A 2016; 26:85-91. [PMID: 26671482 DOI: 10.1089/lap.2015.0343] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Mario Musella
- General Surgery, Advanced Biomedical Sciences Department, “Federico II” University, Naples, Italy
| | - Marco Milone
- General Surgery, Advanced Biomedical Sciences Department, “Federico II” University, Naples, Italy
| | - Paolo Bianco
- General Surgery, Advanced Biomedical Sciences Department, “Federico II” University, Naples, Italy
| | - Paola Maietta
- General Surgery, Advanced Biomedical Sciences Department, “Federico II” University, Naples, Italy
| | - Giuseppe Galloro
- Surgical Endoscopy, Clinical Medicine and Surgery Department, “Federico II” University, Naples, Italy
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Chakravartty S, Sarma DR, Chang A, Patel AG. Staple Line Bleeding in Sleeve Gastrectomy—a Simple and Cost-Effective Solution. Obes Surg 2015; 26:1422-8. [DOI: 10.1007/s11695-015-1986-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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36
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Maietta P, Milone M, Coretti G, Galloro G, Conzo G, Docimo G, Ruggiero R, Musella M. Retrieval of the gastric specimen following laparoscopic sleeve gastrectomy. Experience on 275 cases. Int J Surg 2015; 28 Suppl 1:S124-7. [PMID: 26708855 DOI: 10.1016/j.ijsu.2015.12.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 04/27/2015] [Accepted: 05/15/2015] [Indexed: 02/07/2023]
Abstract
Severe obesity leads to a high incidence of complications and a decrease in life expectancy, especially among younger adults. Laparoscopic sleeve gastrectomy (LSG) first intended as the first step of biliopancreatic diversion with duodenal switch is gaining a per-se procedure role because of its effectiveness on weight loss and comorbidity resolution. Different techniques have been described for specimen extraction in LSG. In this article we report the technique adopted in 275 LSGs performed in our department. In the first 120 LSGs performed from 2007, the specimen was extracted through a mini laparotomy. In the following 155 cases the technique has been simplified: the grasped specimen has been withdrawn through the 15 mm trocar site. We registered in the fist group six cases of wound infection (5%), ten cases of hematoma (8.3%) and four cases of port site hernia (3.3%). In the second group only one case of hematoma (0.6%, p = 0.01) but no cases of wound infection (p = 0.01) or port site hernia, (p = 0.03) although we registered a specimen perforation during retrieval in 16 patients, were reported. The technique described in the 155 cases of the control group has shown to be more effective than the technique we used in the case group, allowing significantly lower operative time (112.9 ± 1.0 vs 74.9 ± 9.1 p < 0.001) and complications, and providing unchanged costs.
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Affiliation(s)
- P Maietta
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy.
| | - M Milone
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy.
| | - G Coretti
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy.
| | - G Galloro
- Department of Clinical Medicine and Surgery, "Federico II" University, Naples, Italy.
| | - G Conzo
- Department of Anaesthesiologic, Surgical and Emergency Sciences, "SUN" Naples Second University, Naples, Italy.
| | - G Docimo
- Department of Medical, Surgical, Neurological and Metabolical Sciences, "SUN" Naples Second University, Naples, Italy.
| | - R Ruggiero
- Department of Medical, Surgical, Neurological and Metabolical Sciences, "SUN" Naples Second University, Naples, Italy.
| | - M Musella
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy.
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Wang Z, Dai X, Xie H, Feng J, Li Z, Lu Q. The efficacy of staple line reinforcement during laparoscopic sleeve gastrectomy: A meta-analysis of randomized controlled trials. Int J Surg 2015; 25:145-52. [PMID: 26700201 DOI: 10.1016/j.ijsu.2015.12.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/22/2015] [Accepted: 12/11/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVE This study was performed to evaluate the effects of staple line reinforcement during laparoscopic sleeve gastrectomy. METHODS Relevant articles published in English (up to July 25, 2015) were identified by searching PubMed, Embase, Web of Knowledge. The outcomes of staple line hemorrhage and leakage, overall complications, operative time were pooled. Data synthesis and statistical analysis were performed using Stata 13.1 software. RESULTS Eight randomized controlled trials involving 791 patients (453 cases and 338 controls) were analyzed. Compared to performing no reinforcement, staple line reinforcement was associated with a lower risk of staple line hemorrhage (RR = 0.609, 95%CI = 0.439-0.846, P = 0.003) and overall complications (RR = 0.673, 95%CI = 0.507-0.892, P = 0.006). No significant difference was observed regarding postoperative leakage (RR = 0.654, 95%CI = 0.275-1.555, P = 0.337). Oversewing of the staple line took longer operative time (WMD = 13.211, 95%CI = 6.192-20.229, P = 0.000). CONCLUSION Staple line reinforcement using buttressing or roofing materials could reduce staple line hemorrhage and overall complications. No obvious advantages of oversewing the staple line were found and it took longer operative time. No significant reduction in leak rate was evidenced after reinforcement.
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Affiliation(s)
- Zhaoming Wang
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China.
| | - Xiaoyu Dai
- Department of Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Haibin Xie
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Jin Feng
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Zhong Li
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Qicheng Lu
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China.
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Morandeira-Rivas A, Moreno-Sanz C, Clerveus M, Muñoz de la Espada-Merlo Córdoba JB, Herrero-Bogajo ML, Román-Ortiz C. Staple line reinforcement for adults undergoing bariatric surgery with gastric transection. Hippokratia 2015. [DOI: 10.1002/14651858.cd011853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Antonio Morandeira-Rivas
- Mancha Centro General Hospital; General and Digestive Surgery; Avd. De la Constitución No. 3 Alcázar de San Juan Ciudad Real Spain 13600
| | - Carlos Moreno-Sanz
- Mancha Centro General Hospital; General and Digestive Surgery; Avd. De la Constitución No. 3 Alcázar de San Juan Ciudad Real Spain 13600
| | - Michael Clerveus
- Mancha Centro General Hospital; General and Digestive Surgery; Avd. De la Constitución No. 3 Alcázar de San Juan Ciudad Real Spain 13600
| | | | - Mari Luz Herrero-Bogajo
- Mancha Centro General Hospital; General and Digestive Surgery; Avd. De la Constitución No. 3 Alcázar de San Juan Ciudad Real Spain 13600
| | - Carmen Román-Ortiz
- Mancha Centro General Hospital; Research Support Unit; Avd. de la Constitución 3 -Alcazar de San Juan -Ciudad Real Spain
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Scognamiglio F, Travan A, Rustighi I, Tarchi P, Palmisano S, Marsich E, Borgogna M, Donati I, de Manzini N, Paoletti S. Adhesive and sealant interfaces for general surgery applications. J Biomed Mater Res B Appl Biomater 2015; 104:626-39. [PMID: 25891348 DOI: 10.1002/jbm.b.33409] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 01/15/2015] [Accepted: 02/26/2015] [Indexed: 12/16/2022]
Abstract
The main functions of biological adhesives and sealants are to repair injured tissues, reinforce surgical wounds, or even replace common suturing techniques. In general surgery, adhesives must match several requirements taking into account clinical needs, biological effects, and material features; these requirements can be fulfilled by specific polymers. Natural or synthetic polymeric materials can be employed to generate three-dimensional networks that physically or chemically bind to the target tissues and act as hemostats, sealants, or adhesives. Among them, fibrin, gelatin, dextran, chitosan, cyanoacrylates, polyethylene glycol, and polyurethanes are the most important components of these interfaces; various aspects regarding their adhesion mechanisms, mechanical performance, and resistance to body fluids should be taken into account to choose the most suitable formulation for the target application. This review aims to describe the main adhesives and sealant materials for general surgery applications developed in the past decades and to highlight the most important aspects for the development of future formulations.
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Affiliation(s)
| | - Andrea Travan
- Department of Life Sciences, University of Trieste, Italy
| | | | - Paola Tarchi
- Department of Medical, Surgical and Health Sciences, Internal Medicine Clinic, University of Trieste, Italy
| | - Silvia Palmisano
- Department of Medical, Surgical and Health Sciences, Internal Medicine Clinic, University of Trieste, Italy
| | - Eleonora Marsich
- Department of Medical, Surgical and Health Sciences, Internal Medicine Clinic, University of Trieste, Italy
| | | | - Ivan Donati
- Department of Life Sciences, University of Trieste, Italy
| | - Nicolò de Manzini
- Department of Medical, Surgical and Health Sciences, Internal Medicine Clinic, University of Trieste, Italy
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Minimizing Hemorrhagic Complications in Laparoscopic Sleeve Gastrectomy—a Randomized Controlled Trial. Obes Surg 2015; 25:1577-83. [DOI: 10.1007/s11695-015-1580-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Bariatric surgery in elderly patients. A comparison between gastric banding and sleeve gastrectomy with five years of follow up. Int J Surg 2014; 12 Suppl 2:S69-S72. [PMID: 25159229 DOI: 10.1016/j.ijsu.2014.08.377] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/15/2014] [Indexed: 01/13/2023]
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