Clinical Benefit of Gastric Staple Line Reinforcement (SLR) in Gastrointestinal Surgery: a Meta-analysis
Open accessAbstract
Background: The objective of this study was to assess whether the use of staple line reinforcement (SLR) reduces staple line complications (SLC). Mechanical staple lines are essential for gastrointestinal surgery such as bariatric surgery. However, SLC, such as bleeding and leakage, still occur. The purposes of this study were to provide quantitative evidence on the relative efficacy of gastric SLR and to compare the rates of effectiveness of three commonly used methods. Methods: A search of the medical literature in English language journals identified studies from Jan 1, 2000, to Dec 31, 2013, using the following reinforcement types: (1) no reinforcement, (2) oversewing, (3) a biocompatible glycolide copolymer, and (4) bovine pericardium after gastric bypasses and sleeve gastrectomies. Types of reinforcement were compared using a random-effects model. Results: This meta-analysis reviewed 16,967 articles, extracting data on 56,309 patients concerning leak and 41,864 patients concerning bleeding. Over 40 % of patients had no reinforcement, resulting in the highest leak rate (2.75 %) and bleed rate (3.45 %). Overall, reinforcing with bovine pericardium had the lowest leak (1.28 %) and bleed (1.23 %) rates. Suture oversewing was better than no reinforcement but not as effective as bovine pericardium for leak (2.45 %) and bleed (2.69 %) rates. Buttressing with a biocompatible glycolide copolymer resulted in the second highest leak rate (2.61 %) and a bleed rate of 2.48 % but had significantly lower bleed rates than no reinforcement. Conclusions: SLR provided superior results for patients compared to no reinforcement for reducing SLC. Buttressing with bovine pericardium resulted in the most favorable outcomes. The effectiveness of different methods used to reinforce the staple line in gastric surgery does not appear to be equal.
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There was a trend towards lower risk of leak with staple line reinforcement in sleeve gastrectomy (RR 0.60, 95% CI 0.27 to 1.50), without reaching significance.
“There was a trend towards lower risks of bleeding (RR 0.56, 95% CI 0.25 to 1.27) and leak (0.60, 95% CI 0.27 to 1.50) without reaching significance, however, effect estimates were imprecise and the certainty of evidence for these outcomes downgraded (Supplementary Table S14).”
Staple line reinforcement in sleeve gastrectomy was associated with a 30% lower risk for complications overall (RR 0.7, 95% CI 0.5 to 0.9).
“Staple line reinforcement was associated with a 30% lower risk for complications overall (RR 0.7, 95% CI 0.5 to 0.9) and this finding was associated with high certainty.”
There was a trend towards lower risk of bleeding with staple line reinforcement in sleeve gastrectomy (RR 0.56, 95% CI 0.25 to 1.27), without reaching significance.
“There was a trend towards lower risks of bleeding (RR 0.56, 95% CI 0.25 to 1.27) and leak (0.60, 95% CI 0.27 to 1.50) without reaching significance, however, effect estimates were imprecise and the certainty of evidence for these outcomes downgraded (Supplementary Table S14).”
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Research works printed but not linked: 1
- [35]Consten ECJ Gagner M Pomp A 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 1360 6 10.1381/0960892042583905 15603652 · DOI
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Di Lorenzo, N., Antoniou, S. A., Batterham, R. L., Busetto, L., Godoroja, D., Iossa, A., Carrano, F. M., Agresta, F., Alarçon, I., Azran, C., et al. (2020) · Surgical Endoscopy · doi:10.1007/s00464-020-07555-y · Cited by 465 · see citing works
- Authors
- Shikora, S. A., & Mahoney, C. B.
- Affiliations
- Brigham and Women's Hospital (US)
- Minnesota State University, Mankato (US)
- Corresponding author
- Shikora, Scott A.
- Venue
- Obesity Surgery
- Published
- 2015-05-13
- Volume
- 25
- Issue
- 7
- Pages
- 1133-1141
- ISSN
- 0960-8923 (ISSN-L)
- 1708-0428
- PMC
- PMC4460272
- OpenAlex
- W253841595
- Cited by
- 210
- References
- 52
- Citations by year
- 2026: 15 · 2025: 14 · 2024: 18 · 2023: 20 · 2022: 22 · 2021: 19 · 2020: 14 · 2019: 24 · 2018: 20 · 2017: 26 · 2016: 15 · 2015: 3
- FWCI
- 4.08
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Obesity Surgery (publishedVersion, cc-by)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Health Sciences › Medicine › Surgery › Surgical Sutures and Adhesives
- Keywords
- staple line reinforcement
- MeSH terms
- Animals, Cattle, Gastrectomy, Humans, Obesity, Morbid, Pericardium, Laparoscopy, Stomach, Sutures, Gastric Bypass, Surgical Stapling, Risk Assessment, Bariatric Surgery
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