Comparative Study Between Different Techniques of Staple Line Reinforcement in Laparoscopic Sleeve Gastrectomy Versus No Reinforcement, as Regards Leakage and Bleeding Rates: A Systematic Review and Meta-Analysis

Background Among several bariatric procedures, laparoscopic sleeve gastrectomy (LSG) is currently the most popular worldwide owing to its technical simplicity, effectiveness, and safety. Compared to the other surgical procedures, LSG is particularly notable for the little derangement of the gastrointestinal tract (GIT) anatomy, maintaining the intestine intact without excluding portions resulting in malabsorption, or performing multiple anastomoses with subsequent increased risks. Furthermore, it can be converted into other bariatric procedure if needed. Aim of the Work The aim of the study was to perform a comprehensive evaluation of the most commonly utilized techniques for staple line reinforcement and assessment of their impact on staple line bleeding and leakage rates as compared to no reinforcement in patients undergoing LSG. Patients and Methods This study was a systemic review in which all patients who underwent LSG as a primary bariatric procedure were included except those with comorbid conditions contributing to presumed increased risk of bleeding or leakage from staple line e.g bleeding disorders, malnourished patients and patients who present for redo LSG. To fulfil the objectives of the study the researchers, based on the recent national and international guidelines, collected all available data and study types published on PubMed tackling assessment of staple line reinforcement impact on bleeding and leakage rates and were incorporated in this systematic review with no restrictions over the publication dates provided they incorporate the latest evidence-based knowledge. For the statistical analysis, a t-test was utilized to compare the two study groups, with a p-value < 0.05 considered significant. Additionally, ANOVA was employed to compare more than two study groups, with a p-value < 0.05 considered significant. Results Reinforcement techniques (n = 2473) had a postoperative bleeding incidence of 2.14% (range: 0.0 – 8.0%). No reinforcement (n = 1641) had a higher postoperative bleeding incidence of 3.72% (range: 0.0 – 16.0%). The p-value for this comparison is < 0.001, indicating a statistically significant difference. Reinforcement techniques (n = 2473) had a leak incidence of 1.72% (range: 0.0 – 8.0%). No reinforcement (n = 1641) had a slightly lower leak incidence of 1.64% (range: 0.0 – 6.67%). The p-value for this comparison is 0.089, indicating that there is no statistically significant difference in postoperative leak incidence between reinforcement and no reinforcement techniques. Conclusion Reinforcement techniques reduced the incidence of staple-line bleeding but did not decrease the incidence of staple line leaks.