A systematic review of staple-line reinforcement in laparoscopic sleeve gastrectomy

Abstract

Background and objectives: Laparoscopic sleeve gastrectomy is gaining popularity as a bariatric procedure, with outcomes similar to gastric band and gastric bypass. Staple-line disruption is a significant source of morbidity and death. We aim to evaluate the effect of staple-line reinforcement on the gastric leak rate, morbidity, and mortality rate.

Methods: A systematic review was performed using title key words "sleeve gastrectomy," and articles were reviewed for description of operative technique and postoperative outcomes including staple-line leak. Rates of leak, bleeding, surgical-site infection, reintervention, readmission, and mortality were analyzed. We calculated pooled event rates and 95% confidence intervals using fixed-effects modeling to determine differences between the reinforcement group (group A) and non-reinforcement group (group B).

Results: We identified 390 articles, and 30 met the inclusion criteria. Group A had 3293 patients, and group B had 1588 patients. After heterogeneity calculations, 9 variables met the criteria to be analyzed. The leak rate was 3.9% (95% confidence interval, 2.9%-5.5%) in group A and 3.2% (95% confidence interval, 2.8%-4.1%) in group B. The mortality rate was 0.8% (95% confidence interval, 0.4%-1.5%) in group A and 0.7% (95% confidence interval, 0.4%-1.1%) in group B. Our results also showed no statistical difference for any of our other 7 outcome variables.

Conclusion: Our study shows a lack of statistical difference in leak rate, overall morbidity, or mortality rate in laparoscopic sleeve gastrectomy with or without staple-line reinforcement. Because of study limitations, we propose that prospective trials are needed to determine the effect of staple-line reinforcement on leak rates.

Figure 1.

Flowchart of study selection methodology.

Figure 2.

Forest plot of pooled event rates of odds ratios for gastric leak rates of group A (reinforced) and group B (non-reinforced) for each article. The squares indicate the event rates, and the lines indicate the extent of the 95% CI. Summative pooled event rates are shown with 95% CIs in parentheses.

Figure 3.

Forest plot of pooled event rates of odds ratios for mortality rates of group A (reinforced) and group B (non-reinforced) for each article. The squares indicate the event rates, and the lines indicate the extent of the 95% CI. Summative pooled event rates are shown with 95% CIs in parentheses.

Figure 4.

Forest plot of pooled event rates of odds ratios for perioperative bleeding rates of group A (reinforced) and group B (non-reinforced) for each article. The squares indicate the event rates, and the lines indicate the extent of the 95% CI. Summative pooled event rates are shown with 95% CIs in parentheses.

Figure 5.

Forest plot of pooled event rates of odds ratios for reintervention rates of group A (reinforced) and group B (non-reinforced) for each article. The squares indicate the event rates, and the lines indicate the extent of the 95% CI. Summative pooled event rates are shown with 95% CIs in parentheses.