Staple-Line Reinforcement with a Thrombin Matrix During Laparoscopic Sleeve Gastrectomy for Morbid Obesity: A Case Series

Background: Laparoscopic sleeve gastrectomy (LSG) represents a valid option for morbidly obese patients, either as a primary or as a staged procedure. Staple-line reinforcement (SLR) is strongly advocated to decrease the chance of bleeding. The aim of this article is to report our experience with a new technique of SLR using a thrombin-gelatin matrix in a series of morbidly obese patients subjected to LSG. Subjects and Methods: Patients subjected to LSG using a thrombin-gelatin matrix for SLR from April 2010 to April 2011 were included in the study. Each patient's record was registered and prospectively collected for the analysis. Results: Seventy-four patients were subjected to LSG using a thrombin matrix for SLR. There were 56 female and 18 male subjects with a mean age of 44.8 years (range, 16-64 years). Mean preoperative body mass index was 46.2 kg/m(2) (range, 40-72 kg/m(2)). Mean operative time was 74.4 minutes (range, 58-96 minutes). Mean time for application of the thrombin matrix was 4.8 minutes (range, 3.2-6.6 minutes). Mean postoperative hospital stay was 3.4 days (range, 2-62 days). Mean follow-up was 8.2 months (range, 3-12 months). Mean postoperative body mass index was 36.2 kg/m(2) (range, 30-42 kg/m(2)), and mean percentage excess weight loss was 34.2% (range, 28.4%-42.8%). We observed two major postoperative complications (2.7%): One gastric stump leak (1.3%) and one major bleeding from the trocar site (1.3%), both successfully treated by laparoscopic re-exploration. Conclusion: LSG with a thrombin matrix for SLR is a safe operation and a valid alternative to other well-established techniques.