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. 2021 Aug;406(5):1683-1690.
doi: 10.1007/s00423-021-02161-5. Epub 2021 Apr 7.

Staple-line reinforcement using barbed sutures in 1008 sleeve gastrectomies

Görkem Özgen  1 , İsmail Çalıkoğlu  1 , Bülent Acunaş  2 , Mehmet Ali Yerdel  3
Affiliations

Staple-line reinforcement using barbed sutures in 1008 sleeve gastrectomies

Görkem Özgen et al. Langenbecks Arch Surg. 2021 Aug.

Abstract

Purpose: Among various staple-line reinforcement methods applied during sleeve gastrectomy (SG), although data on full-thickness-continuous-suturing (FTCS) is nearly nil, it has been considered as potentially harmful. The safety/efficacy profile of FTCS is assessed.

Methods: All consecutive SGs completing 3-month follow-up were studied. Data on peri-operative parameters, complications, and follow-up were prospectively recorded. All reinforcements were completed by FTCS utilizing barbed suture. Super-super obese, secondary SGs, SGs performed in patients with prior anti-reflux surgery, and SGs performed with additional concomitant procedures were evaluated as "technically demanding" SGs. Student's t/chi-square tests were used as appropriate.

Results: Between January 2012 and July 2020, 1008 SGs (941 "primary-standard," 67 "technically demanding") were performed without mortality/venous event. Single leak occurred in a patient with sleeve obstruction (0.1%). Thirteen bleedings, 4 requiring re-surgery (0.4%), and 17 stenoses (1.7%) were encountered. Four stenoses were treated with gastric bypass (1 emergency), 6 by dilatation(s), and one required parenteral nutrition. Six patients with stenosis chose not to have any treatment. No statistically significant difference was observed in postoperative complications between "primary-standard" and "technically demanding" SGs (p > 0.05). The median follow-up was 44 months. The excess weight loss % at 5th year was 80.1%. Suturing added 28.4 ± 6 minutes to the SG, 3 or fewer sutures were used to complete the reinforcement in > 95%. No mishap/complication occurred related to suturing.

Conclusion: FTCS produced excellent result in terms of leakage/hemorrhage with an acceptable stenosis rate at a low cost with half-an-hour increase in the operating time. In contrast to previous allegations, no harm attributable to stitching itself occurred.

Keywords: Complications; Full-thickness suturing; Over-sewing; Sleeve gastrectomy; Staple-line reinforcement.

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Conflict of interest statement

The authors declare no competing interests.

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