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. 2025 Mar;35(3):992-1000.
doi: 10.1007/s11695-025-07727-6. Epub 2025 Feb 4.

Perioperative Outcomes of Staple Line Reinforcement During Laparoscopic and Robotic Sleeve Gastrectomy: An MBSAQIP Cohort Study of 284,580 Patients

Sebastian Leon  1 , Armaun D Rouhi  2 , Sara P Ginzberg  1 , Juan E Perez  1 , Colleen M Tewksbury  1 , Victoria M Gershuni  1 , Maria S Altieri  1 , Noel N Williams  1 , Kristoffel R Dumon  3
Affiliations

Perioperative Outcomes of Staple Line Reinforcement During Laparoscopic and Robotic Sleeve Gastrectomy: An MBSAQIP Cohort Study of 284,580 Patients

Sebastian Leon et al. Obes Surg. 2025 Mar.

Abstract

Background: This study evaluated the association between staple line reinforcement (SLR) and 30-day outcomes in patients undergoing laparoscopic (LSG) or robotic sleeve gastrectomy (RSG).

Methods: Adults undergoing primary LSG or RSG with and without SLR were analyzed from the 2018-2019 Metabolic and Bariatric Surgery Accreditation and Quality Improvement (MBSAQIP) database. Baseline characteristic differences by SLR status for LSG and RSG were adjusted using entropy balancing. Multivariable weighted logistic and linear regression was then performed to examine the association between SLR and primary and secondary outcomes.

Results: Of 284,580 patients, 88.6% (n = 252,035) had LSG and 11.4% (n = 32,545) had RSG, of which 63.7% (n = 160,545) and 50.8% (n = 16,541) had SLR, respectively. Compared to LSG and RSG without SLR, both LSG and RSG with SLR encountered higher adjusted odds of emergency department visit (AOR 1.08, 95%CI 1.03-1.10, p < 0.001; AOR 1.10, 95%CI 1.01-1.20, p = 0.029, respectively) as well as lower adjusted odds of leakage (AOR 0.85, 95%CI 0.76-0.94, p = 0.002; AOR 0.71, 95%CI 0.54-0.92, p = 0.011, respectively) and gastrointestinal bleeding (AOR 0.79, 95%CI 0.77-0.91, p < 0.001; AOR 0.77, 95%CI 0.70-0.84, p < 0.001, respectively). LSG with SLR was also associated with greater odds of unplanned intubation (AOR 1.52, 95%CI 1.16-1.99, p = 0.002) and mechanical ventilation (AOR 1.74, 95%CI 1.22-2.50, p = 0.002). RSG with SLR was associated with higher odds of intraoperative conversion (AOR 1.71, 95%CI 1.15-2.54, p = 0.008), and lower odds of acute renal failure (AOR 0.27, 95%CI 0.11-0.65, p = 0.003).

Conclusions: This entropy-balanced analysis of the MBSAQIP registry demonstrated an overall association between SLR and lower postoperative leakage and bleeding after RSG and LSG.

Keywords: Bariatric surgery; Bleeding; Laparoscopic; Leakage; MBSAQIP; Outcomes; Robotic; Sleeve gastrectomy; Staple line reinforcement.

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Conflict of interest statement

Declarations. Ethical Approval: This article does not contain any studies with human participants or animals performed by any of the authors. Informed Consent: Informed consent does not apply. Competing Interests: The authors declare no competing interests.

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