Efficiency and safety of electrocoagulation as a means of local hemostasis of the staple line in bariatric surgery

OBJECTIVE Comparative analysis of two methods of processing the stapler line during bariatric interventions: monopolar coagulation and application of metal clips. MATERIAL AND METHODS For the study, from May 2021 to November 2021, 160 patients were selected who were sent to the Centrosouz Hospital of the Russian Federation for bariatric surgical treatment. There were 99 (61.88%) females and 61 (38.12%) males. The average age of the patients was 39±4.2 years, the average body mass index was 41±4.2 kg/m². Patients underwent the following surgical interventions: sleeve gastrectomy, Roux-en-Y gastric bypass and gastric bypass with one anastomosis. Using a random number generator, all patients were divided into 2 groups: in group A, hemostasis of the staple line was carried out using superficial monopolar coagulation, in group B — by applying separate metal clips. In order to evaluate the results of the study and compare the two groups, three control points were selected: two to assess the effectiveness and one to assess the safety of the hemostasis methods being studied. Efficacy was assessed by monitoring drainage discharge in the first 12 hours after surgery and the number of hemorrhagic complications according to the Clavien-Dindo scale. Safety was assessed by monitoring the consistency of the staple line. RESULTS In most patients, the amount of hemorrhagic discharge through the drainage 12 hours after surgery ranged from 50 to 150 ml, and the distribution of patients according to this criterion did not depend on belonging to the study group (p= 0.752). In addition, it was found that the number of hemorrhagic complications classified by Clavien-Dindo as class II or higher did not differ statistically significantly in the study groups (p=0.605). When assessing safety, there were also no differences between the groups: in none of them were complications associated with the failure of the stapler suture recorded. CONCLUSION Monopolar coagulation of the staple line in bariatric surgery showed no differences in the incidence of complications compared with the technique of applying metal clips.