Staple Line Treatment and Bleeding After Laparoscopic Sleeve Gastrectomy.

Autor:	Zafar SN; Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland., Felton J; Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland., Miller K; School of Medicine, University of Maryland, Baltimore, Maryland., Wise ES; Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland., Kligman M; Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland.
Jazyk:	angličtina
Zdroj:	JSLS : Journal of the Society of Laparoendoscopic Surgeons [JSLS] 2018 Oct-Dec; Vol. 22 (4).
DOI:	10.4293/JSLS.2018.00056
Abstrakt:	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. Competing Interests: Conflicts of Interest: The authors have no conflicts of interest or financial ties to disclose.
Databáze:	MEDLINE
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