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Review
, 17 (3), 390-9

A Systematic Review of Staple-Line Reinforcement in Laparoscopic Sleeve Gastrectomy

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Review

A Systematic Review of Staple-Line Reinforcement in Laparoscopic Sleeve Gastrectomy

Jean Knapps et al. JSLS.

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.

Figures

Figure 1.
Figure 1.
Flowchart of study selection methodology.
Figure 2.
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.
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.
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.
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.

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