Background

Staple line reinforcement can be divided into 4 categories: Oversewing, gluing, buttressing, and omentopexy/gastropexy (OP/GP). The aim of this study is to compare the postoperative outcomes of staple line reinforcement during sleeve gastrectomy using Seamguard versus oversewing.

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 Seamguard buttressing versus oversewing of the staple line revealed statistically significant increase in length of stay (MD 0.86, CI 0.37, 1.34) and decrease in operative time (OR -16.09, CI -21.31, -10.86) with Seamguard. In addition, analysis revealed statistically insignificant increases in leaks (OR 1.61, CI 0.31, 8.41) and postoperative bleeding (OR 1.53, CI 0.18, 12.72). Meta-analysis of observational studies revealed statistically significant decrease in re-operations (OR 0.41, CI 0.17, 0.96). In addition, analysis revealed statistically insignificant decrease in leaks (OR 0.91, CI 0.42, 1.98) and increase in postoperative bleeding (OR 1.40, CI 0.83, 2.38), length of stay (MD 0.08, CI -0.08, 0.25), and readmissions (OR 1.46, CI 0.78, 2.72).

Conclusions

Although Seamguard is more expensive than oversewing, operative time is less by 16 minutes. In addition, Seamguard decreases the risk of re-operations. Although increased length of stay with Seamgaurd is statistically significant, it is clinically insignificant as the difference is only 0.08 days, which is less than 2 hours.