Skip to main content
SpringerLink
Log in

Clinical and Economic Evaluation of Absorbable Staple Line Buttressing in Sleeve Gastrectomy in High-Risk Patients

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Gastric leaks and bleeding are the most important complications after laparoscopic sleeve gastrectomy (LSG). The use of absorbable membranes as staple line reinforcement may decrease this risk. On the other hand, these materials bring additional costs and their economic impact is not well known. The purpose of this study was to assess the clinical and economic performance of one of the commercially available buttressing absorbable materials when treating a high-risk population.

Methods

A retrospective, observational, and comparative study was conducted at Montpellier University Hospital, France, between July 2013 and September 2014. Patients undergoing LSG, who were at a high risk for leaks and bleeding, were included and treated according to two groups: no buttressing (July 2013 to January 2014) and buttressing (February 2014 to September 2014). Clinical and economic outcomes were measured throughout the first 6 months.

Results

Two hundred two patients were included in the study: 116 during the no stapling reinforcement period and 86 during the buttressing period. Baseline characteristics were similar. There was no significant difference between the two groups regarding gastric leaks. However, buttressing reduced hemorrhagic complications (0 vs 8.6 %, p = 0.005) and decreased average total hospital costs for the first hospitalization (5768 vs 6025 €, p < 0.001), as well as 6-month total inpatient cost (5944 vs. 6246 €, p < 0.001).

Conclusions

Staple line reinforcement with absorbable material reduces bleeding in high-risk population. Therefore, this type of material can also result in cost-savings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Consten ECJ, Gagner M, Pomp A, et al. Decreased bleeding after laparoscopic sleeve gastrectomy with or without duodenal switch for morbid obesity using a stapled buttressed absorbable polymer membrane. Obes Surg. 2004;14(10):1360–6.

    Article  PubMed  Google Scholar 

  2. Gagner M, Deitel M, Kalberer TL, et al. The Second International Consensus Summit for Sleeve Gastrectomy, March 19–21, 2009. Surg Obes Relat Dis Off J Am Soc Bariatr Surg août. 2009;5(4):476–85.

    Google Scholar 

  3. Gagner M, Buchwald JN. Comparison of laparoscopic sleeve gastrectomy leak rates in four staple-line reinforcement options: a systematic review. Surg Obes Relat Dis Off J Am Soc Bariatr Surg août. 2014;10(4):713–23.

    Google Scholar 

  4. Bransen J, Gilissen LPL, van Rutte PWJ, et al. Costs of leaks and bleeding after sleeve gastrectomies. Obes Surg. 2015;25(10):1767–71.

    Article  PubMed  Google Scholar 

  5. Benedix F, Benedix DD, Knoll C, et al. Are there risk factors that increase the rate of staple line leakage in patients undergoing primary sleeve gastrectomy for morbid obesity? Obes Surg. 2014;24(10):1610–6.

    Article  PubMed  Google Scholar 

  6. Germanova D, Loi P, van Vyve E, et al. Previous bariatric surgery increases postoperative morbidity after sleeve gastrectomy for morbid obesity. Acta Chir Belg. 2013;113(4):254–7.

    Article  CAS  PubMed  Google Scholar 

  7. Parikh M, Issa R, McCrillis A, et al. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg. 2013;257(2):231–7.

    Article  PubMed  Google Scholar 

  8. D’Ugo S, Gentileschi P, Benavoli D, et al. Comparative use of different techniques for leak and bleeding prevention during laparoscopic sleeve gastrectomy: a multicenter study. Surg Obes Relat Dis Off J Am Soc Bariatr Surg juin. 2014;10(3):450–4.

    Google Scholar 

  9. Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26(6):1509–15.

    Article  PubMed  Google Scholar 

  10. van Rutte PWJ, Smulders JF, de Zoete JP, et al. Indications and short-term outcomes of revisional surgery after failed or complicated sleeve gastrectomy. Obes Surg. 2012;22(12):1903–8.

    Article  PubMed  Google Scholar 

  11. Pugliese R, Maggioni D, Sansonna F, et al. Efficacy and effectiveness of suture bolster with Seamguard. Surg Endosc. 2009;23(6):1415–6.

    Article  PubMed  Google Scholar 

  12. Busse R, Geissler A, Aaviksoo A, et al. Diagnosis related groups in Europe: moving towards transparency, efficiency, and quality in hospitals? BMJ. 2013;346:f3197.

    Article  PubMed  Google Scholar 

  13. Husereau D, Drummond M, Petrou S, et al. Consolidated health economic evaluation reporting standards (CHEERS) statement. BMJ. 2013;346:f1049.

    Article  PubMed  Google Scholar 

  14. Chen B, Kiriakopoulos A, Tsakayannis D. Reinforcement does not necessarily reduce the rate of staple line leaks after sleeve gastrectomy. A review of the literature and clinical experiences. Obes Surg. 2009;19(2):166–72.

    Article  PubMed  Google Scholar 

  15. Durmush EK, Ermerak G, Durmush D. Short-term outcomes of sleeve gastrectomy for morbid obesity: does staple line reinforcement matter? Obes Surg. 2014;24(7):1109–16.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Sroka G, Milevski D, Shteinberg D, et al. Minimizing hemorrhagic complications in laparoscopic sleeve gastrectomy—a randomized controlled trial. Obes Surg. 2015;25(9):1577–83.

    Article  PubMed  Google Scholar 

  17. Knapps J, Ghanem M, Clements J, et al. A systematic review of staple-line reinforcement in laparoscopic sleeve gastrectomy. JSLS J Soc Laparoendosc Surg Soc Laparoendosc Surg. 2013;17(3):390–9.

    Article  Google Scholar 

  18. Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA, et al. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2012;8(1):8–19.

    Article  Google Scholar 

  19. Shikora SA, Mahoney CB. Clinical benefit of gastric staple line reinforcement (SLR) in gastrointestinal surgery: a meta-analysis. Obes Surg. 2015;25(7):1133–41.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Ser K-H, Lee W-J, Lee Y-C, et al. Experience in laparoscopic sleeve gastrectomy for morbidly obese Taiwanese: staple-line reinforcement is important for preventing leakage. Surg Endosc. 2010;24(9):2253–9.

    Article  PubMed  Google Scholar 

  21. Stamou KM, Menenakos E, Dardamanis D, et al. Prospective comparative study of the efficacy of staple-line reinforcement in laparoscopic sleeve gastrectomy. Surg Endosc. 2011;25(11):3526–30.

    Article  PubMed  Google Scholar 

  22. Silecchia G, Rizzello M, Casella G, et al. Two-stage laparoscopic biliopancreatic diversion with duodenal switch as treatment of high-risk super-obese patients: analysis of complications. Surg Endosc. 2009;23(5):1032–7.

    Article  CAS  PubMed  Google Scholar 

  23. Daskalakis M, Berdan Y, Theodoridou S, et al. Impact of surgeon experience and buttress material on postoperative complications after laparoscopic sleeve gastrectomy. Surg Endosc. 2011;25(1):88–97.

    Article  Google Scholar 

  24. Miller KA, Pump A. Use of bioabsorbable staple reinforcement material in gastric bypass: a prospective randomized clinical trial. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2007;3(4):417–21. discussion 422.

    Article  Google Scholar 

  25. Dapri G, Cadière GB, Himpens J. Reinforcing the staple line during laparoscopic sleeve gastrectomy: prospective randomized clinical study comparing three different techniques. Obes Surg. 2010;20(4):462–7.

    Article  PubMed  Google Scholar 

  26. Baker RS, Foote J, Kemmeter P, et al. The science of stapling and leaks. Obes Surg. 2004;14(10):1290–8.

    Article  PubMed  Google Scholar 

  27. Yuval JB, Mintz Y, Cohen MJ, et al. The effects of bougie caliber on leaks and excess weight loss following laparoscopic sleeve gastrectomy. Is there an ideal bougie size? Obes Surg. 2013;23(10):1685–91.

    Article  PubMed  Google Scholar 

  28. Kassir R, Blanc P, Amor IB, et al. Division of the stomach and checking haemostasis for performing sleeve gastrectomy. Points of controversy. Obes Surg. 2015;25(3):537–8.

    Article  PubMed  Google Scholar 

  29. Mery CM, Shafi BM, Binyamin G, et al. Profiling surgical staplers: effect of staple height, buttress, and overlap on staple line failure. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2008;4(3):416–22.

    Article  Google Scholar 

  30. Ye X, Lafuma A, Torreton E, et al. Incidence and costs of bleeding-related complications in French hospitals following surgery for various diagnoses. BMC Health Serv Res. 2013;13:186.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Conflict of Interest

Xavier Gayrel, Marcelo Loureiro, El Mehdi Skalli, Camille Dutot, and Gregoire Mercier have no conflicts of interest or financial ties to disclose. David Nocca received honorarium for speaking engagements from Ethicon Endo-Surgery, MSD, Gore, and created patents for MID.

Ethical Approval

For this type of study, formal consent is not required.

Author information

Authors and Affiliations

  1. CHU de Montpellier, Montpellier, France

    X. Gayrel, M. Loureiro, E.M. Skalli, C. Dutot, G. Mercier & D. Nocca

  2. Universidade Positivo, Curitiba, Brazil

    M. Loureiro

  3. Université Montpellier 1, Montpellier, France

    M. Loureiro, G. Mercier & D. Nocca

Authors
  1. X. Gayrel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Loureiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E.M. Skalli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Dutot
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Mercier
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D. Nocca
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to X. Gayrel.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gayrel, X., Loureiro, M., Skalli, E. et al. Clinical and Economic Evaluation of Absorbable Staple Line Buttressing in Sleeve Gastrectomy in High-Risk Patients. OBES SURG 26, 1710–1716 (2016). https://doi.org/10.1007/s11695-015-1991-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-015-1991-1

Keywords

Search

Navigation