Page 57 - World Journal of Laparoscopic Surgery

WJOLS

Novel Technique in Laparoscopic Staple-line Reinforcement

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Fig. 2: Final fixation of the hemostatic material to the stapler Fig. 3: Sleeve gastrectomy using the new technique of SNoW
load with two ties reinforce stapler

in the era of increasing demand on bariatric surgery due the staple line on firing. Features of ideal buttressing
to the increasing epidemic of obesity worldwide. material should include enhancement of the strength of
Three different techniques have mainly been pro- the staple line during healing process and the material
posed in the literature to prevent staple-line bleeding should also be flexible and thin enough for easy cutting
including oversuturing, buttressing material and appli- by the stapler blade.
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cation of tissue glue or sealant agent. Dapri et al have A similar technique has been described in the
published the only randomized clinical trial compar- literature by using Surgicel Nu-knit (considered to be
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ing the outcome of three different reinforcements: No too thick for white load) reinforcement with glue fixation
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enforcement, Gore Seamguard and staple-line over- (usually difficult to find) and has been done in Roux-en-Y
sewing with polydioxanone; the study demonstrated gastric bypass, but there is no study in sleeve gastrectomy
significantly lower blood loss in the buttressing group or other applications. 8
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with Gore Seamguard but with longer operative time
and higher cost (640–890 euros). Other studies in the CONCLUSION
literature are low in power and do not address cost per
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se. Buttressing material is becoming widely used as a Stapler-line reinforcement with SURGICEL SNoW or
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means of lowering intraoperative as well as postoperative SURGICEL Original fixed with suture in this novel
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complications ; moreover, it is associated with lower technique is safe, practical, convenient and affordable.
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complication in early surgeon experience. A number of
staple-line buttressing reinforcements described in the REFERENCES
literature include bioabsorbable polyglycolic acid and 1. Lattouf JB, Beri A, Klinger CH, Jeschke S, Janetschek G.
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trimethylene carbonate (Gore Seamguard ), nonabsorb- Practical hints for hemostasis in laparoscopic surgery. Minim
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able bovine pericardium (Peri-Strips Dry ) and small Invasive Ther Allied Technol 2007;16(1):45-51.
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bowel submucosa (Surgisis ). 2. Dapri G, Cadiere GB, Himpens J. Reinforcing the staple line
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Gagner and Buchwald reported Gore Seamguard during laparoscopic sleeve gastrectomy; prospective rand-
to be the best hemostatic material with possible added omized clinical study comparing three different techniques.
Obese Surg 2010 Apr;20(4):462-467.
benefit of decreasing staple-line leaks to 1.1% in a study 3. Albanopoulos K, Alevizos L, Flessas J, Menenakos E, Sta-
of 8,900 sleeve gastrectomy as compared with 2% in mou KM, Papailiou J, Natoudi M, Zografos G, Leandros E.
oversuture, 2.2% in nonreinforcement and 3.3% in Peri- Reinforcing the staple line during laparoscopic sleeve gas-
Strips group. trectomy: prospective randomized clinical study comparing
Unfortunately, these materials are expensive, costing two different techniques. Preliminary results. Obes Surg 2012
US$280 in the author’s country for each load with Jan;22(1):42-46.
approximate total cost in laparoscopic sleeve gastrectomy 4. Rosenthal RJ, International Sleeve Gastrectomy Expert Panel,
equal to US$1,500 for one operation, while the net cost of Diaz AA, Arvidsson D, Baker RS, Basso N, Bellanger D,
Boza C, El Mourad H, France M, et al. International sleeve
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the used Surgicel and the ties is around US$200. gastrectomy expert panel consensus statement best practice
The buttressing material needs to be preloaded guidelines based on experience of >12,000 cases. Surg Obes
onto the stapler handle and become incorporated into Relat Dis 2012 Jan-Feb;8(1):8-19.
World Journal of Laparoscopic Surgery, May-August 2016;9(2):104-106 105