The efficacy of staple line reinforcement during laparoscopic sleeve gastrectomy: A meta-analysis of randomized controlled trials
Open accessAbstract
OBJECTIVE: This study was performed to evaluate the effects of staple line reinforcement during laparoscopic sleeve gastrectomy. METHODS: Relevant articles published in English (up to July 25, 2015) were identified by searching PubMed, Embase, Web of Knowledge. The outcomes of staple line hemorrhage and leakage, overall complications, operative time were pooled. Data synthesis and statistical analysis were performed using Stata 13.1 software. RESULTS: Eight randomized controlled trials involving 791 patients (453 cases and 338 controls) were analyzed. Compared to performing no reinforcement, staple line reinforcement was associated with a lower risk of staple line hemorrhage (RR = 0.609, 95%CI = 0.439-0.846, P = 0.003) and overall complications (RR = 0.673, 95%CI = 0.507-0.892, P = 0.006). No significant difference was observed regarding postoperative leakage (RR = 0.654, 95%CI = 0.275-1.555, P = 0.337). Oversewing of the staple line took longer operative time (WMD = 13.211, 95%CI = 6.192-20.229, P = 0.000). CONCLUSION: Staple line reinforcement using buttressing or roofing materials could reduce staple line hemorrhage and overall complications. No obvious advantages of oversewing the staple line were found and it took longer operative time. No significant reduction in leak rate was evidenced after reinforcement.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
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 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).”
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).”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & for the PRISMA Group (2009) · BMJ · doi:10.1136/bmj.b2535 · Cited by 83,823 · see citing works
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The PRISMA Group (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000097 · Cited by 64,042 · see citing works
Bias in meta-analysis detected by a simple, graphical test
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997) · BMJ · doi:10.1136/bmj.315.7109.629 · Cited by 56,722 · see citing works
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement.
(2009) · PubMed Central · Cited by 44,859 · see citing works
Meta-analysis in clinical trials
DerSimonian, R., & Laird, N. (1986) · Controlled Clinical Trials · doi:10.1016/0197-2456(86)90046-2 · Cited by 39,552 · see citing works
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2009.06.005 · Cited by 19,575 · see citing works
Assessing the quality of reports of randomized clinical trials: Is blinding necessary?
Jadad, A. R., Moore, R. A., Carroll, D., Jenkinson, C., Reynolds, D. J. M., Gavaghan, D. J., & McQuay, H. J. (1996) · Controlled Clinical Trials · doi:10.1016/0197-2456(95)00134-4 · Cited by 17,582 · see citing works
Statistical Aspects of the Analysis of Data From Retrospective Studies of Disease
(1959) · JNCI: Journal of the National Cancer Institute · doi:10.1093/jnci/22.4.719 · Cited by 14,689 · see citing works
Bariatric Surgery: A Systematic Review and Meta-analysis
Buchwald, H., Avidor, Y., Braunwald, E., Jensen, M. D., Pories, W., Fahrbach, K., & Schoelles, K. (2004) · JAMA · doi:10.1001/jama.292.14.1724 · Cited by 6,800 · see citing works
Levesque, R. J. R. (2017) · Springer eBooks · doi:10.1007/978-3-319-32132-5_447-2 · Cited by 4,059 · see citing works
Levesque, R. J. R. (2018) · Springer eBooks · doi:10.1007/978-3-319-33228-4_447 · Cited by 1,698 · see citing works
Ren, C. J., Patterson, E., & Gagner, M. (2000) · Obesity Surgery · doi:10.1381/096089200321593715 · Cited by 601 · see citing works
Gagner, M., Deitel, M., Erickson, A. L., & Crosby, R. D. (2013) · Obesity Surgery · doi:10.1007/s11695-013-1040-x · Cited by 362 · see citing works
Deitel, M., Crosby, R. D., & Gagner, M. (2008) · Obesity Surgery · doi:10.1007/s11695-008-9471-5 · Cited by 332 · see citing works
Carlin, A. M., Zeni, T. M., English, W. J., Hawasli, A. A., Genaw, J. A., Krause, K. R., Schram, J. L., Kole, K. L., Finks, J. F., Birkmeyer, J. D., et al. (2013) · Annals of Surgery · doi:10.1097/sla.0b013e3182879ded · Cited by 321 · see citing works
D’Hondt, M. A., Vanneste, S., Pottel, H., Devriendt, D., Rooy, F. V., & Vansteenkiste, F. (2011) · Surgical Endoscopy · doi:10.1007/s00464-011-1572-x · Cited by 269 · see citing works
Dapri, G., Cadière, G. B., & HIMPENS, J. M. (2009) · Obesity Surgery · doi:10.1007/s11695-009-0047-9 · Cited by 232 · see citing works
Chen, B., Kiriakopoulos, A., Tsakayannis, D., et al. (2008) · Obesity Surgery · doi:10.1007/s11695-008-9668-7 · Cited by 217 · see citing works
Choi, Y. Y., Bae, J.-M., Hur, K. Y., et al. (2012) · Obesity Surgery · doi:10.1007/s11695-012-0674-4 · Cited by 144 · see citing works
D’Ugo, S., Gentileschi, P., Benavoli, D., et al. (2013) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2013.10.018 · Cited by 120 · see citing works
Systematic Reviews on Rehabilitation Interventions
Handoll, H. H. (2006) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2006.04.006 · Cited by 114 · see citing works
Gentileschi, P., Camperchioli, I., D’Ugo, S., et al. (2012) · Surgical Endoscopy · doi:10.1007/s00464-012-2243-2 · Cited by 111 · see citing works
Miller, K. A., & Pump, A. (2007) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2007.03.244 · Cited by 109 · see citing works
Use of a Roux Limb to Correct Esophagogastric Junction Fistulas after Sleeve Gastrectomy
Baltasar, A., Bou, R., Bengochea, M., et al. (2007) · Obesity Surgery · doi:10.1007/s11695-007-9222-z · Cited by 102 · see citing works
Laparoscopic Sleeve Gastrectomy without an Over-Sewing of the Staple Line
Kasalicky, M., Michalský, D., Housova, J., Haluzı́k, M., Housa, D., Haluzíková, D., & Fried, M. (2008) · Obesity Surgery · doi:10.1007/s11695-008-9635-3 · Cited by 92 · see citing works
Tissue thickness of human stomach measured on excised gastric specimens from obese patients.
Elariny, H. A., González, H. L., & Wang, B. (2005) · PubMed · Cited by 74 · see citing works
Sroka, G., Milevski, D., Shteinberg, D., et al. (2015) · Obesity Surgery · doi:10.1007/s11695-015-1580-3 · Cited by 69 · see citing works
Musella, M., Milone, M., Maietta, P., et al. (2014) · Updates in Surgery · doi:10.1007/s13304-014-0257-0 · Cited by 60 · see citing works
Laparoscopic sleeve gastrectomy. Do we need to oversew the staple line?
Musella, M., Milone, M., Bellini, M., et al. (2011) · PubMed · Cited by 55 · see citing works
Laparoscopic Sleeve Gastrectomy
Hayes, K., & Eid, G. M. (2016) · Surgical Clinics of North America · doi:10.1016/j.suc.2016.03.015 · Cited by 53 · see citing works
Aggarwal, S., Sharma, A. J., & Ramaswamy, N. (2013) · Journal of Laparoendoscopic & Advanced Surgical Techniques · doi:10.1089/lap.2013.0137 · Cited by 51 · see citing works
A Bariatric Surgery Center of Excellence: Operative Trends and Long-Term Outcomes
Kruger, R. S., Pricolo, V. E., Streeter, T. T., Colacchio, D. A., & Andrade, U. A. (2014) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2014.01.056 · Cited by 48 · see citing works
Shah, S. S., Todkar, J. S., & Shah, P. S. (2014) · Obesity Surgery · doi:10.1007/s11695-014-1374-z · Cited by 45 · see citing works
Consten, E. C. J., & Gagner, M. (2004) · PubMed · Cited by 32 · see citing works
Bülbüller, N., Aslaner, A., Öner, O. Z., et al. (2013) · PubMed · Cited by 26 · see citing works
Machado, M. A. C., Surjan, R. C. T., & MAKDISSI, F. F. (2015) · Journal of Laparoendoscopic & Advanced Surgical Techniques · doi:10.1089/lap.2015.0032 · Cited by 17 · see citing works
Staple Line Reinforcement with Stitch in Laparoscopic Sleeve Gastrectomies. Is It Useful or Harmful?
Albanopoulos, K., Tsamis, D., Arapaki, A., et al. (2015) · Journal of Laparoendoscopic & Advanced Surgical Techniques · doi:10.1089/lap.2014.0433 · Cited by 16 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- Center for Evidence-Based Medicine, Oxford Centre for Evidence-based Medicine -Levels of Evidence (March 2009), CEBM, 2009. Available from: http://www.cebm.net/oxford-centre-evidence-based-medicine-levels- evidence-march-2009/.
Cited by
Sorted by citations
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
- Wang, Z., Dai, X., Xie, H., Feng, J., Li, Z., & Lu, Q.
- Affiliations
- Soochow University (CN)
- Corresponding author
- Lu, Qicheng
- Venue
- International Journal of Surgery
- Published
- 2016-01
- Volume
- 25
- Pages
- 145-152
- ISSN
- 1743-9159 (ISSN-L)
- 1743-9191
- OpenAlex
- W2214233722
- Cited by
- 74
- References
- 37
- Citations by year
- 2025: 2 · 2024: 7 · 2023: 8 · 2022: 8 · 2021: 7 · 2020: 10 · 2019: 14 · 2018: 7 · 2017: 5 · 2016: 6
- FWCI
- 1.15
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- International Journal of Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Keywords
- staple line reinforcement, laparoscopic sleeve gastrectomy, staple line leakage, postoperative complications, operative time, oversewing, roofing materials, bariatric surgery
- MeSH terms
- Gastrectomy, Humans, Laparoscopy, Incidence, Randomized Controlled Trials as Topic, Surgical Stapling, Postoperative Hemorrhage, Operative Time
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
