OPTIMIZING SURGICAL OUTCOMES IN LAPAROSCOPIC SLEEVE GASTRECTOMY THE ROLE OF STAPLE LINE OVERSEWING IN ENHANCING PATIENT SAFETY AND EFFICACY

Main Article Content

Dr. Faheem Khan
Waleed Anjum
Aqsa Amin
Mohammad Yassin

Keywords

Laparoscopic sleeve gastrectomy, Staple line oversewing, postoperative complications, surgical efficacy, bariatric surgery, patient-reported outcomes, cost-effectiveness, surgical reinforcement, obesity surgery, clinical practice

Abstract

Purpose: This paper aims to compare staple line oversewing concerning postoperative complications, patient satisfaction and cost-effectiveness in a laparoscopic sleeve gastrectomy (LSG) setting. Since there is still controversy about the utilization and efficiency of staple line reinforcement, the present paper attempts to present data that would complement common knowledge.
Objective: The primary objectives are to determine whether staple line oversewing reduces the incidence of postoperative leaks and bleeding, enhances better management of patient pain and satisfaction rates and identifies cost-effectiveness in Laparoscopic sleeve gastrectomy (LSG) procedures.
Methodology: In the current study, quantitative, cross-sectional research was used, and the study recruited 210 Laparoscopic sleeve gastrectomy (LSG) patients. Thrown for structured questionnaires and medical records were also analyzed, if any. To evaluate the effect of staple line oversewing, various descriptive statistical tests such as Independent Samples T-Tests, Mann-Whitney U Tests, Pearson Correlation and inferential statistical test Logistic Regression were used. Furthermore, the study also engaged in data visualizations with the application of bar plots, box plots, scatter plots, and coefficient plots for purposes of comparing the results of the interventions between groups and testing the strength in association with the variables. The evaluation of cost-effectiveness was done utilizing the cost-benefit analysis considering such costs that might be directly and indirectly linked with the procedure.
Results: By analyzing the experimental results, the researchers have found out that there was no statistically significant difference between the two groups; the oversewing group and the no oversewing group, so the result was calculated with the p-value of 0.284. Likewise, the rate of bleeding was also in a similar percentage (p=0.337). The level of pain management did not reach statistically significant whether oversewn or not (mean difference 0.2 p 0.412); similarly, the overall patient satisfaction was similar (median difference 0.3 p= 0.465). Thus, Pearson correlation analysis showed that age was not related to pain management scores r = -0.05 p = 0.721. The Statistical test applied logistic regression and revealed that age has a significant relationship with Postoperative Complication (Odds Ratio= 1.75, p=0.041); however, BMI category and oversewing were not found to have any significant relationship. The cost advantage study showed that the added cost of oversewing as compared to the standard suture was not compensated by reduced costs due to complications, thereby reporting very slight economic merits of oversewn sutures (p= 0.589). The bar graph and Box graph further ensured that differences in the results of processes involving oversewing and non-overswinging were also statistically insignificant.
Practical Implications: This indicates that perhaps staple line oversewing is not needed in every Laparoscopic sleeve gastrectomy (LSG) as there was no substantial decrease in the complications and proved to be financially unwise. It can be suggested that, based on these results, surgeons should base their decisions related to oversewing on several risk factors of a specific patient and use the method mostly where the possibilities of complications are higher. Novelty: Taking a closer look at Laparoscopic sleeve gastrectomy (LSG), this work discusses the necessity of utilizing staple line oversewing, as well as its effectiveness and influence on patients’ outcomes and the healthcare cost and raises a question about the rationale of such an untamed practice in Laparoscopic sleeve gastrectomy (LSG).
Conclusion: Oversew of the staple line in laparoscopic sleeve gastrectomy is not of great value because it does not decrease postoperative complications, there is almost no difference in patient-reported outcomes and does not save many costs. Such studies indicate that targeted application of this technology based on the patient’s characteristics may be more suitable than conventional approaches. Future work is still required to provide more effective guidelines and develop best Surgical practices in Laparoscopic sleeve gastrectomy (LSG).

Abstract 69 | pdf Downloads 20

References

1. Abdurakhmanov, A., & Nimeri, A. (2023). Role of Endoscopic Bariatric Therapies in a Comprehensive Multidisciplinary Metabolic and Bariatric Program The SAGES Manual Operating Through the Endoscope (pp. 699-715): Springer.
2. Aboueisha, M. A., Freeman, M., Allotey, J. K., Evans, L., Caposole, M. Z., Tatum, D., . . . Galvani, C. (2023). Battle of the buttress: a 5-year propensity-matched analysis of staple-line reinforcement techniques from the MBSAQIP database. Surgical Endoscopy, 37(4), 3090-3102.
3. Abu-Abeid, A., Gosher, N., Schnell, M., Fishman, S., Keidar, A., Lahat, G., & Eldar, S. M. (2024). Revision of restrictive bariatric procedures in elderly patients: results at a 5-year follow-up. Updates in Surgery, 1-7.
4. Addison, P., Bitner, D. P., Addy, J., Dechario, S., Husk, G., Antonacci, A., . . . Filicori, F. (2023). Does Surgeon Experience Correlate with Crowd-Sourced Skill Assessment in Robotic Bariatric Surgery? The American Surgeon™, 89(12), 5253-5262.
5. Aderinto, N., Olatunji, G., Kokori, E., Olaniyi, P., Isarinade, T., & Yusuf, I. A. (2023). Recent advances in bariatric surgery: a narrative review of weight loss procedures. Annals of Medicine and Surgery, 85(12), 6091-6104.
6. Adrenalectomy, L. S. L., Unmed Chandak, M., & Bansod, P. Y. 2024 Scientific Session of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), Cleveland, USA, 17–20 April 2024: Video Loop.
7. Almalki, O. M. (2024). Towards zero bleeding after laparoscopic sleeve gastrectomy: investigating the impact of prophylactic tranexamic acid. International Surgery Journal, 11(6), 879-885.
8. Alqahtani, A. R. (2023). Endoscopic Sleeve Gastroplasty The SAGES Manual Operating Through the Endoscope (pp. 783-811): Springer.
9. Baldwin, D., Ali, A. M., Altieri, M. S., & DeMaria, E. J. (2024). Marginal ulceration after Roux-en-Y gastric bypass-literature review and management algorithm. Metab Target Organ Damage, 4(1), 6.
10. Belluzzi, A., Sample, J. W., Marrero, K., Tomey, D., Puvvadi, S., Sharma, I., & Ghanem, O. M. (2024). Rare Complications Following Laparoscopic Sleeve Gastrectomy. Journal of Clinical Medicine, 13(15), 4456.
11. Bigolin, A. V., Iaroseski, J., de Lima, J. N. C., Machry, M. C., Bonamigo, E. R., Grossi, J. V. M., . . . Silveira, I. V. d. (2023). Optimization of Surgical Time Through the Implementation of a Rational Protocol to Prevent Bleeding in Sleeve Gastrectomy. Journal of Laparoendoscopic & Advanced Surgical Techniques, 33(1), 15-20.
12. Binda, C., Jung, C. F. M., Fabbri, S., Giuffrida, P., Sbrancia, M., Coluccio, C., . . . Fabbri, C. (2023). Endoscopic management of postoperative oesophagal and upper GI defects—A narrative review. Medicina, 59(1), 136.
13. Bindal, V., Gupta, S., Pandey, D., & Goel, T. (2024). Laparoscopic sleeve gastrectomy in a 2-year-old child with morbid obesity: A case report with a 2-year follow-up. Journal of Minimal Access Surgery, 10.4103.
14. Chaouch, M. A., Khalfallah, M., Jabra, S. B., Jouilli, M., Sallem, O. K., Nouira, R., & Noomen, F. (2024). Omentopexy versus no omentopexy in sleeve gastrectomy: an updated systematic review and meta-analysis. Updates in Surgery, 76(3), 811-827.
15. Chen, J. Y., & Shikora, S. A. (2024). Long-Term Complications of Bariatric Surgery Bariatric Surgery (pp. 193-209): CRC Press.
16. Chiu, P. W.-y., Zhou, S., & Dong, Z. (2023). A look into the future of endoscopic submucosal dissection and third space endoscopy: the role for robotics and other innovation. Gastrointestinal Endoscopy Clinics, 33(1), 197-212.
17. Coker, A., Sebastian, R., Tatum, J., Cornejo, J., Zevallos, A., Li, C., . . . Adrales, G. (2023). Do advances in technology translate to improved outcomes? Comparing robotic bariatric surgery outcomes over two-time intervals utilizing the MBSAQIP database. Surgical Endoscopy, 37(10), 7970-7979.
18. Dalkılıç, M. S., Gençtürk, M., Şişik, A., & Erdem, H. (2024). Enhancing bariatric surgery safety for patients refusing blood transfusions: a specialized protocol with comprehensive technical measures. Updates in Surgery, 1-6.
19. Dayan, D. (2024). Implementation of Artificial Intelligence–Based Computer Vision Model for Sleeve Gastrectomy: Experience in One Tertiary Center. Obesity Surgery, 34(2), 330-336.
20. de Oliveira, V. L., Bestetti, A. M., Trasolini, R. P., de Moura, E. G. H., & de Moura, D. T. H. (2023). Choosing the best endoscopic approach for post-bariatric surgical leaks and fistulas: Basic principles and recommendations. World Journal of Gastroenterology, 29(7), 1173.
21. Diab, A.-R. F., Sher, T., Awshah, S., Noom, M., Docimo Jr, S., Sujka, J. A., & DuCoin, C. G. (2023). Oversewing/suturing of the staple line during sleeve gastrectomy is an effective and affordable staple line reinforcement method: a meta-analysis of randomized controlled trials. Obesity Surgery, 33(8), 2533-2545.
22. Estrada, A., Rodriguez-Quintero, J. H., Pereira, X., Moran-Atkin, E., Choi, J., & Camacho, D. (2024). Gastric bypass revisional surgery: percentage total body weight loss differences among three different techniques. Langenbeck's Archives of Surgery, 409(1), 1-8.
23. Firkins, S. A., & Simons-Linares, R. (2024). Management of Leakage and Fistulas after Bariatric Surgery. Best Practice & Research Clinical Gastroenterology, 101926.
24. Freitas, D., & Parikh, M. (2023). The Evolving Management of Leaks Following Sleeve Gastrectomy. Current Surgery Reports, 11(7), 168-175.
25. GALA, K. S., & ACOSTA, A. J. (2024). Complications After Roux-en-Y Surgery. Mayo Clinic Gastroenterology and Hepatology Board Review, 159.
26. Gallo, A., D’alisa, R., Di Spiezio Sardo, A., Guerra, S., Berardi, G., Vitale, S. G., . . . Bifulco, G. (2024). Hysteroscopy and weight loss in treatment of endometrial cancer: case report and literature review. Minimally Invasive Therapy & Allied Technologies, 33(2), 109-119.
27. Gambardella, C., Parisi, S., Tolone, S., Lucido, F. S., Del Genio, G., Brusciano, L., . . . Pizza, F. (2024). Does Antrum Size Matter in Sleeve Gastrectomy? Volume II—A Retrospective Multicentric Study with Long-Term Follow-Up. Journal of Clinical Medicine, 13(13), 3912.
28. Goens, D., Johnson-Mann, C. N., Zarrinpar, A., & Patton, H. (2024). Surgical treatment of obesity for NAFLD Metabolic Steatotic Liver Disease (pp. 221-244): Elsevier.
29. Gormsen, J., Poulsen, I. M., Engberg, A. S., Erichsen, S. B., Lassen, C. B., & Helgstrand, F. (2024). Long-term outcomes of laparoscopic sleeve gastrectomy in Denmark from 2010 to 2016: a nationwide cohort study. Surgery for Obesity and Related Diseases.
30. Goyal, M., Bains, A., Singh, Y., Deepali, F., Singh, A., Sood, S., & Buttar, N. S. (2024). Endoscopic management of surgical complications. Best Practice & Research Clinical Gastroenterology, 101898.
31. Helmy, R. F., Elbanna, M. R., El-Zemeity, A. O., Abozeid, T. A., & Fadl, E. M. (2023). Management of early postoperative bleeding after OAGB: a single-centre experience. Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 33(6), 617-621.
32. Hsu, J. L., & Farrell, T. M. (2024). Updates in bariatric surgery. The American Surgeon™, 90(5), 925-933.
33. Jawhar, N., Sample, J. W., Salame, M., Marrero, K., Tomey, D., Puvvadi, S., & Ghanem, O. M. (2024). The Trajectory of Revisional Bariatric Surgery: Open to Laparoscopic to Robotic. Journal of Clinical Medicine, 13(7), 1878.
34. Jing, W., Huang, Y., Feng, J., Li, H., Yu, X., Zhao, B., & Wei, P. (2023). The clinical effectiveness of staple line reinforcement with different matrices used in surgery. Frontiers in Bioengineering and Biotechnology, 11, 1178619.
35. Jung, C. F. M., Binda, C., Tuccillo, L., Secco, M., Gibiino, G., Liverani, E., . . . Fabbri, C. (2024). New Endoscopic Devices and Techniques for the Management of Post-Sleeve Gastrectomy Fistula and Gastric Band Migration. Journal of Clinical Medicine, 13(16), 4877.
36. Khandhar, S. J., Desai, N. P., Anselme, S., Shersher, D. D., Seder, C. W., & Sanchez, P. G. (2024). A real-world study evaluating the safety and utility of a two-row stapler reload on pulmonary vasculature. Journal of Thoracic Disease.
37. Kumar, N., & Thompson, C. C. (2024). Endoscopy in the Bariatric Patient Bariatric Surgery (pp. 263-278): CRC Press.
38. Li, M., Zeng, N., Liu, Y., Sun, X., Yang, W., Liu, Y., . . . Liang, H. (2023). Management and outcomes of gastric leak after sleeve gastrectomy: results from the 2010–2020 national registry. Chinese Medical Journal, 136(16), 1967-1976.
39. Lo, H.-C., Hsu, S.-C., Soong, R.-S., & Huang, S.-K. (2024). Unravelling postoperative bleeding dynamics in laparoscopic roux-en-Y Gastric bypass: Insights from a single-centre tranexamic acid study. Obesity Surgery, 1-9.
40. Lorentzen, J. H. (2024). Impact of diabetes and bariatric surgery on gastroesophageal reflux disease and patient-reported outcomes: A cross-sectional study of patients with and without type 2 diabetes, and a randomized study (Oseberg) comparing the short-and medium-term effects of gastric bypass and sleeve gastrectomy on gastroesophageal reflux disease and patient-reported outcomes.
41. Masood, M., Low, D. E., Deal, S. B., & Kozarek, R. A. (2024a). Current Management and Treatment Paradigms of Gastroesophageal Reflux Disease following Sleeve Gastrectomy. Journal of Clinical Medicine, 13(5), 1246.
42. Masood, M., Low, D. E., Deal, S. B., & Kozarek, R. A. (2024b). Endoscopic Management of Post-Sleeve Gastrectomy Complications. Journal of Clinical Medicine, 13(7), 2011.
43. Mauro, A., Lusetti, F., Scalvini, D., Bardone, M., De Grazia, F., Mazza, S., . . . Sgarlata, C. (2023). A comprehensive review on bariatric endoscopy: where we are now and where we are going. Medicina, 59(3), 636.
44. Mocanu, V., Wilson, H., Verhoeff, K., Kung, J., Walsh, C., Koloszvari, N., . . . Karmali, S. (2023). Role of tranexamic acid (TXA) in preventing bleeding following sleeve gastrectomy: a systematic review and meta-analysis. Obesity Surgery, 33(5), 1571-1579.
45. Mohmed, A. H.-E., Ali, M. M., & Helmy, M. Z. (2024). Short-Term Impact of Laparoscopic Sleeve Gastrectomy versus Gastric Bypass on Body Weight and Common Associated Comorbidities: Review Literature. Sohag Medical Journal.
46. Musbahi, M. A. BOMSS 2024 Congress Abstracts.
47. Needs, P. Bariatric Surgery.
48. Niaz, O., Askari, A., Currie, A., Mcglone, E. R., Zakeri, R., Khan, O., . . . Al‐Taan, O. (2024). Analysis of the effect of staple line reinforcement on leaking and bleeding after sleeve gastrectomy from the UK National Bariatric Surgery Registry. World Journal of Surgery.
49. Peters, X., Sweigert, P., & Chand, B. (2023). Upper Gastrointestinal Tract Leaks The SAGES Manual Operating Through the Endoscope (pp. 183-211): Springer.
50. Raj, P. P., Gupta, P., & Kumar, S. S. (2023). Laparoscopic Sleeve Gastrectomy: Late (> 30-Days) Complications–Diagnosis and Management Obesity, Bariatric and Metabolic Surgery: A Comprehensive Guide (pp. 479-493): Springer.
51. Rashad, A. E., El Hefnawy, E., Elmorshedi, M., Abuyousif, Y. A., Salem, A., Attia, M., . . . Mohammed, M. N. (2023). Prevalence, risk factors, and management of postoperative nausea and vomiting after laparoscopic sleeve gastrectomy (a retrospective multicentric study). Obesity Surgery, 33(10), 3237-3245.
52. Rose, S. M., & Ahmed, A. R. (2023). Laparoscopic Roux-en-Y Gastric Bypass: Complications–Diagnosis and Management Obesity, Bariatric and Metabolic Surgery: A Comprehensive Guide (pp. 347-376): Springer.
53. Seicean, R., Puscasu, D., Gheorghiu, A., Pojoga, C., Seicean, A., & Dindelegan, G. (2023). Anastomotic Leakage after Gastrectomy for Gastric Cancer. Journal of Gastrointestinal & Liver Diseases, 32(4).
54. Subedi, A., Suhail, F. K., Singh, K., & Adler, D. G. (2024). Endoscopic Management of Laparoscopic Gastric Sleeve Leaks. PRACTICAL GASTROENTEROLOGY, 39.
55. Suh, H. R., Mui, J., Cheng, E., Liu, D., Sun, S. L., Loi, K., . . . Gagner, M. (2023). Outcomes of single anastomosis duodenal ileal bypass and single anastomosis stomach ileal bypass for type II diabetes: A systematic review. Expert Review of Endocrinology & Metabolism, 18(4), 337-346.
56. Szvarca, D., & Jirapinyo, P. (2024). Endoscopic Management of Weight Regain After Bariatric Surgery. Gastrointestinal Endoscopy Clinics.
57. Tariq, N., Saharia, A., Nwokedi, U., Hobeika, M. J., Mobley, C. M., Hsu, D., . . . Sherman, V. (2023). Combined liver transplantation and sleeve gastrectomy: Report of a brief‐interval staged approach. Liver Transplantation, 29(4), 422-430.
58. Tish, S., & Corcelles, R. (2024). The Art of Sleeve Gastrectomy. Journal of Clinical Medicine, 13(7), 1954.
59. Tsai, C., Dolan, P., Moss, N., Sandoval, A. F., Roldan, J., & Herron, D. M. (2023). Sleeve gastrectomy facilitates weight loss and permits cardiac transplantation in patients with severe obesity and a left ventricular assist device (LVAD). Surgical Endoscopy, 37(11), 8655-8662.
60. van den Wildenberg, L. (2023). Development of a surgical tool to facilitate mesenteric defect closure: Using an alternative method to close mesenteric windows during minimally invasive gastric bypass surgery.
61. Wang, Y., Zuo, S., Ma, Y., Shen, J., Chu, Q., & Yang, Z. (2023). Effect of Ultrasound-guided Erector Spinae Plane Block on Recovery After Laparoscopic Sleeve Gastrectomy in Patients With Obesity: A Randomized Controlled Trial. Clinical Therapeutics, 45(9), 894-900.
62. Weiner, R. A., & Weiner, S. (2023). Laparoscopic Sleeve Gastrectomy: Early Complications Obesity, Bariatric and Metabolic Surgery: A Comprehensive Guide (pp. 465-477): Springer.
63. Yadlapati, S., Sánchez-Luna, S. A., Gromski, M. A., & Mulki, R. (2024). Managing the Bariatric Surgery Patient: Presurgery and Postsurgery Considerations. Gastrointestinal Endoscopy Clinics.
64. Zambrano, A. K., Paz-Cruz, E., Ruiz-Pozo, V. A., Cadena-Ullauri, S., Tamayo-Trujillo, R., Guevara-Ramírez, P., . . . Simancas-Racines, D. (2024). Microbiota dynamics preceding bariatric surgery as obesity treatment: a comprehensive review. Frontiers in Nutrition, 11, 1393182.
65. Zarzycki, P., Rymarowicz, J., Małczak, P., Pisarska-Adamczyk, M., Mulek, R., Binda, A., . . . Group, P. C. S. (2023). Differences in Technical Aspects of Primary Sleeve Gastrectomy before Redo Bariatric Surgery—A Multicenter Cohort Study (PROSS Study). Medicina, 59(4), 799.

Most read articles by the same author(s)