Background

Staple line reinforcement can be divided into 4 categories: Oversewing, gluing, buttressing, and omentopexy/gastropexy. The aim of this study is to compare the outcomes of staple line gluing (fibrin gluing), 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 observational studies comparing fibrin glue versus no staple line reinforcement revealed statistically insignificant decrease in leaks (OR 0.37, CI 0.07, 1.99) and postoperative bleeding (OR 0.24, CI 0.02, 2.34), statistically insignificant increase in re-operations (OR 1.32, CI 0.40, 4.42), and statistically significant decrease in operative time (MD -4.21, CI -6.81, -1.62). Meta-analysis of randomized controlled trials comparing fibrin glue versus no staple line reinforcement revealed statistically insignificant decrease in leaks (OR 0.44, CI 0.09, 2.15), postoperative bleeding (OR 0.61, CI 0.17, 2.17), and length of stay (MD -0.01, CI -0.42, 0.40), and statistically insignificant increase in readmissions (OR 1.42, CI 0.67, 3.02), and operative time (MD 2.28, CI -2.51, 7.08).

Conclusions

This review’s limitation is the small number of studies published on this matter in the literature. Studies with larger sample sizes might be able to statistically prove that the application of fibrin glue can reduce leaks and postoperative bleeding.