Background

Staple line reinforcement can be divided into 4 categories: Oversewing/suturing, gluing, buttressing, and omentopexy/gastropexy. The aim of this study is to compare the outcomes of staple line oversewing/suturing versus control (no staple line reinforcement) during sleeve gastrectomy.

Methods

Literature search was done according to the PRISMA guidelines. Meta-analysis was done using the RevMen 5.4.1 software. Statistical method used was Mantel-Haenszel. Analysis model used was random effects regardless of the heterogeneity (I2).

Results

Meta-analysis of randomized controlled trials comparing oversewing/suturing versus no staple line reinforcement revealed statistically significant decrease in leaks (OR 0.45, CI 0.21, 0.96) and postoperative bleeding (OR 0.29, CI 0.15, 0.55), and statistically significant increase in excess weight loss at 12 months (MD 6.58, CI 2.14, 11.02) and operative time (MD 17.46, CI 12.53, 22.38). In addition, analysis revealed statistically insignificant increase in wound infections (OR 2.57, CI 0.48, 13.75) and stenosis/stricture (OR 1.34, CI 0.22, 8.00), and statistically insignificant decrease in abscess formation (OR 0.54, CI 0.12, 2.38), re-operation(s) (OR 0.41, CI 0.12, 1.43), and length of stay (MD -0.08, CI -0.24, 0.09).

Conclusions

Although oversewing/suturing decreases the incidence of leaks and bleeding, the mean increase of 17.5 minutes in operative time is excessive. Studies comparing between oversewing/suturing and other staple line reinforcement techniques are warranted, as other techniques might be equally effective with less operative time. However, it is interesting that oversewing/suturing resulted in an increase in excess weight loss at 12 months.