Biologic staple line reinforcement for laparoscopic sleeve gastrectomy: A case series

Background: Laparoscopic Sleeve Gastrectomy (LSG) is currently the most common bariatric procedure worldwide. Staple Line Reinforcement (SLR) with biological or synthetic material has been recommended to reduce complications such as staple line bleeding and leakage following LSG. SLR devices have been studied and have shown varied results in reducing these complications. Objective: The aim of this study was to evaluate the rate of postoperative bleeding and staple line leakage associated with LSG when using a SLR material made from porcine small intestinal submucosa. Setting: Community Hospital. Methods: This was a single surgeon retrospective case review of all patients who had undergone LSG to treat severe obesity at our institution between January 2012 and August 2016 and had their staple line reinforced with a SLR device made from porcine small intestinal submucosa. Postoperative complications within the 30-day postoperative window, including bleeding and staple line leakage, were recorded. Results: A total of 722 procedures were performed (female, 77%; age, 48.7 +/- 13.2 years; preoperative Body Mass Index, 43.9 +/- 7.6 kg/m(2)). The mean operative time was 109 +/- 40 min and average length of stay was 1.5 days. Postoperative bleeding was noted in 9 patients (1.2%); 2 patients (0.3%) required reoperation for bleeding. Four (0.6%) post-operative staple line leaks were recorded. There was one post-operative death of indeterminate etiology. Conclusions: Staple line reinforcement with porcine small intestinal submucosa has leak and bleed rates comparable to those reported for other staple line reinforcement devices. (C) 2019 The Authors. Published by Elsevier Ltd on behalf of Surgical Associates Ltd.