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ORIGINAL ARTICLE
Year : 2020  |  Volume : 33  |  Issue : 4  |  Page : 1328-1334

Imbrication versus no reinforcement during laparoscopic sleeve gastrectomy


1 Department of General Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Surgery, Abou Kir General Hospital, Alexandria, Egypt

Correspondence Address:
Osama M. M. Moustafa
9 Bakous Alexandria, Beside Tawhid Mousque, Alexandria
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_152_20

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Background Laparoscopic sleeve gastrectomy (LSG) is a common procedure in recent years for treatment of morbid obesity. However, leak and bleeding are its main challenging complications. Despite numerous studies regarding such complications, there is still no conclusion on reinforcement of staple line in this procedure. The purpose of our study was to compare staple line imbrication versus no reinforcement. Objectives To determine the effects of reinforcement of staple line by imbrication using continuous seromuscular invagination using absorbable suture on bleeding, leakage, length of hospital stay, readmission, reoperation rates, and stricture rates. Patients and methods In our pilot study, 60 patients experiencing morbid obesity with BMI above 35 kg/m2 were prepared for LSG. The patients were enrolled randomly into two equal groups comparing the effect of staple line reinforcement by imbrication whole staple line by seromuscular invagination using absorbable suture (group A) versus no reinforcement (group B). The study was conducted in Menoufia University in the period between October 2017 and June 2019. Results Hemorrhage and leak did not occur in group A but occurred in two (6.7%) patients and one (3.3%) patient, respectively, in group B, but stricture occurred in two (6.7%) patients in group A and no patients in group B. Conclusion This pilot study has shown that reinforcement by staple line imbrication as a step in LSG is safe, technically easy, of low cost, and can reduce the incidence of postoperative complications, as bleeding and leakage, although it significantly prolongs the operative time and may lead to increase in the rate of stricture.


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