Background

Staple line reinforcement (SLR) can be divided into 4 categories: Oversewing, gluing, buttressing, and omentopexy/gastropexy (OP/GP). The aim of this study is to compare the outcomes sleeve gastrectomy with versus without Seamguard SLR.

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 observational studies comparing Seamguard SLR with no SLR revealed statistically significant decrease in postoperative bleeding (OR: 0.08, CI 0.03, 0.21), leaks (OR 0.54, CI 0.30, 0.95), length of stay (MD -0.78, CI -1.23, -0.32), and re-operations (OR 0.10, CI 0.03, 0.32). In addition, analysis revealed statistically insignificant decrease in abscess (OR 0.28, CI 0.03, 2.65), and operative time (MD -1.29, CI -31.57, 29.00).

Conclusions

Staple line buttressing with Seamguard leads to very strong reduction in the risk of postoperative bleeding, re-operations, and length of stay. In addition, it reduces the risk of leaks to almost half. Although insignificant, the decrease in abscesses was very close to significance cutoff, and thus larger studies might be able to prove this decrease as statistically significant. As reported in previous research, oversewing of the staple line greatly increase operative duration, therefore we recommend future studies to focus on comparing Seamguard buttressing versus gluing of the staple line, instead of Seamguard buttressing versus oversewing.