The effect of oversewing the staple line in laparoscopic sleeve gastrectomy: randomized control trial

Introduction: Laparoscopic sleeve gastrectomy (LSG) is one of the most popular bariatric procedures. The procedure is associated with serious staple-line complications such as bleeding, leaks, and stenosis. Aim: To determine whether oversewing the staple line, compared with clipping, in LSG reduces the incidence of postoperative bleeding. Material and methods: We conducted a parallel-group, prospective, randomized controlled trial (RCT) of 100 patients who underwent LSG for obesity at a single institution between May 2014 and August 2015. Patients were assigned to one of two groups for reinforcement of the staple line: the oversewing group (staple line oversewn) or the clipping group (staple line clipped). The primary outcome was reoperation for hemodynamic instability caused by staple-line bleeding within 72 h postoperatively. The secondary outcomes were operative duration, length of hospital stay, postoperative leaks, and postoperative stenosis. Results: Mean operative duration was longer in the oversewing group (78.2 +/- 20.5 min) than in the clipping group (64.1 +/- 16.5 min, p < 0.001). Mean length of hospital stay was comparable in both groups. Postoperatively, there was no significant between-group difference in bleeding (oversewing, n = 0 vs. clipping, n = 2 (4.6%); p = 0.21) or in stenosis and leakage (both outcomes: oversewing, n = 0, vs. clipping, n = 1 (2.3%); p = 0.46). Conclusions: Oversewing the staple line prolongs operative duration. No conclusions can be drawn regarding the effects of oversewing on staple-line bleeding, postoperative leakage and stenosis, or length of hospital stay.