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Chirurgia 2018 December;31(6):231-6

DOI: 10.23736/S0394-9508.18.04786-1


language: English

A prospective randomized study on staple line reinforcement during laparoscopic sleeve gastrectomy: fibrin glue, Ifabond or none?

Sinan BINBOGA 1 , Hakan SEYIT 1, Elif BINBOGA 2, Pinar KASAPOGLU 3, Osman KONES 1, Ahmet SUREK 1, Eyup GEMICI 1, Halil ALIS 1

1 Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey; 2 Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey; 3 Department of Biochemistry, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey


BACKGROUND: To prevent the morbid obesity that has a daily increasing rate of prevalence, Laparoscopic Sleeve Gastrectomy (LSG) was firstly defined by Gagner in 2003 as one of the most effective surgical application at long-term. The most common complications affecting the morbidity and mortality following LSG surgery are stapler line (SL) leaks and bleeding. The aim of this randomized controlled study is to search contribution of tissue glues used for SL reinforcement during LSG on postoperative complications.
METHODS: Between January 2016 and January 2017, 150 patients scheduled for LSG were prospectively randomized into control group without SL reinforcement (SLR) (group A), Tisseel™ group with SL reinforcement including fibrin glue coverage (group B) and Ifabond® (n-hexyl-CA) group with SL reinforcement including n-hexyl coverage (group C). Primary endpoints were post-operative leaks, bleeding, transfusion and reoperation, while secondary outcomes consisted of the time to perform SLR and total operative time.
RESULTS: Almost all demographic characteristics of the patients were not statistically different between groups. Total operative time and time of hospital stay were 78.50±15.09 min and 4.82±3.41 day for group A; 80.56±20.11 min and 5.80±5.53 day for group B and 85.50±15.26 min and 5.94±5.71 day for group C, without significant difference. None of postoperative complications (SL leaks, SL bleeding, rate of re-hospitalization, stricture application, endoscopic stent placement, blood transfusion, re-hospitalization) were statistically different between groups. Mortality was recorded in only one (2%) of the patient in group C (P=0.64).
CONCLUSIONS: Although tissue glues have been generally used in LSG, they cannot be considered as cost-effective or time-saving. As a result, LSG without SL reinforcement is safe and avoids additional costs for reinforcement materials.

KEY WORDS: Laparoscopy - Gastrectomy - Absorbable implants - Tissue adhesives

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