Staple line reinforcement during laparoscopic sleeve gastrectomy: pros and cons


  • Samir A. Abdelmageed Department of General Surgery, Faculty of Medicine, Sohag University, Sohag
  • Mena Z. Helmy Department of General Surgery, Faculty of Medicine, Sohag University, Sohag



Gastrectomy, Laparoscopic, Reinforcement, Sleeve, Staple line


Background: Nowadays, laparoscopic sleeve gastrectomy (LSG) is the most common performed bariatric procedure. Staple line reinforcement (SLR) advised for reducing gastric leaks and bleeding after LSG. The aim of this study is to evaluate the efficacy of SLR in reducing the postoperative complications compared to non-SLR during LSG.

Method: Sixty morbid obese patients were scheduled for LSG in this prospective randomized study at Sohag University Hospital in the period between March 2016 to February 2018. Patients were divided randomly into two groups: Group I included 30 patients underwent LSG with over sewing of the staple line with running suture using VLoc™ V 3/0 suture. Group II underwent LSG without SLR (n=30).

Results: No cases with leaks or stenosis were detected in our series. The operative time was significantly longer in the SLR group compared to the non-SLR group (125 (110-160) vs 100 (90-125) minutes respectively, p<0.01). Staple line bleeding was detected postoperatively only in one case in group II (3.3%) which was treated conservatively. The length of hospital stay was longer in the non-reinforcement group but not significantly different (p=0.25).

Conclusions: Staple line reinforcement during LSG has no superiority on the outcome of this operation, used by surgeons as a personal preference and as a security shield rather than for its advantages. 


Author Biography

Samir A. Abdelmageed, Department of General Surgery, Faculty of Medicine, Sohag University, Sohag

general surgery


D’Hondt M, Vanneste S, Pottel H, Devriendt D, Van Rooy F, Vansteenkiste F. Laparoscopic sleeve gastrectomy as a single-stage procedure for the treatment of morbid obesity and the resulting quality of life, resolution of comorbidities, food tolerance, and 6-year weight loss. Surgical endoscopy. 2011;25(8):2498-504.

Ponce J, DeMaria EJ, Nguyen NT, Hutter M, Sudan R, Morton JM. American Society for Metabolic and Bariatric Surgery estimation of bariatric surgery procedures in 2015 and surgeon workforce in the United States. Surgr Obesity Related Dis. 2016;12(9):1637-9.

Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obesity Surg. 2013;23(4):427-36.

Paluszkiewicz R, Kalinowski P, Wróblewski T, Bartoszewicz Z, Białobrzeska-Paluszkiewicz J, Ziarkiewicz-Wróblewska B, et al. Prospective randomized clinical trial of laparoscopic sleeve gastrectomy versus open Roux-en-Y gastric bypass for the management of patients with morbid obesity. Videosurg Other Miniinvasive Techniques. 2012;7(4):225.

Rosenthal RJ, Panel IS. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of> 12,000 cases. Surg Obesity Related Dis. 2012;8(1):8-19.

Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Related Dis. 2009;5(4):469-75.

Deitel M, Gagner M, Erickson AL, Crosby RD. Third International Summit: current status of sleeve gastrectomy. Surg Obesity Related Dis. 2011;7(6):749-59.

Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obesity Surg. 2013;23(4):427-36.

Shikora SA, Mahoney CB. Clinical benefit of gastric staple line reinforcement (SLR) in gastrointestinal surgery: a meta-analysis. Obes Surg. 2015;25(7):1133-41.

Gentileschi P, Camperchioli I, D’Ugo S, Benavoli D, Gaspari AL. Staple-line reinforcement during laparoscopic sleeve gastrectomy using three different techniques: a randomized trial. Surgical Endoscopy. 2012;26(9):2623-9.

Benedix F, Benedix DD, Knoll C, Weiner R, Bruns C, Manger T, et al. Obesity Surgery Working Group. Are there risk factors that increase the rate of staple line leakage in patients undergoing primary sleeve gastrectomy for morbid obesity?. Obesity Surg. 2014;24(10):1610-6.

Deitel M. Update: why diabetes does not resolve in some patients after bariatric surgery. Obes Surg. 2011;21(6):794-6.

Gagner M, Kemmeter P. Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review. Surgical Endoscopy. 2019;16:1-2.

Choi YY, Bae J, Hur KY, Choi D, Kim YJ. Reinforcing the staple line during laparoscopic sleeve gastrectomy: does it have advantages? A meta-analysis. Obes Surg. 2012;22(8):1206-13.

Musella M, Milone M, Bellini M, Leongito M, Guarino R, Milone F. Laparoscopic sleeve gastrectomy. Do we need to oversew the staple line. Ann Ital Chir. 2011;82(4):273-7.

Chen B, Kiriakopoulos A, Tsakayannis D, Wachtel MS, Linos D, Frezza EE. Reinforcement does not necessarily reduce the rate of staple line leaks after sleeve gastrectomy. A review of the literature and clinical experiences. Obes Surg. 2009;19(2):166-72.

Wang Z, Dai X, Xie H, Feng J, Li Z, Lu Q. The efficacy of staple line reinforcement during laparoscopic sleeve gastrectomy: a meta-analysis of randomized controlled trials. Int J Surg. 2016;25:145-52.

Aggarwal S, Sharma AP, Ramaswamy N. Outcome of laparoscopic sleeve gastrectomy with and without staple line oversewing in morbidly obese patients: a randomized study. J Laparoendoscopic Adv Surgical Techniques. 2013;23(11):895-9.

Musella M, Milone M, Maietta P, Bianco P, Pisapia A, Gaudioso D. Laparoscopic sleeve gastrectomy: efficacy of fibrin sealant in reducing postoperative bleeding. A randomized controlled trial. Updates in Surg. 2014;66(3):197-201.

Sroka G, Milevski D, Shteinberg D, Mady H, Matter I. Minimizing hemorrhagic complications in laparoscopic sleeve gastrectomy—a randomized controlled trial. Obesity Surg. 2015;25(9):1577-83.

Taha O, Abdelaal M, Talaat M, Abozeid M. A randomized comparison between staple-line oversewing versus no reinforcement during laparoscopic vertical sleeve gastrectomy. Obesity Surg. 2018;28(1):218-25.

Miller KA, Pump A. Use of bioabsorbable staple reinforcement material in gastric bypass: a prospective randomized clinical trial. Surgery for Obesity and Related Diseases. 2007;3(4):417-21.

Kasalicky M, Michalsky D, Housova J, Haluzik M, Housa D, Haluzikova D, et al. Laparoscopic sleeve gastrectomy without an over-sewing of the staple line. Obesity Surg. 2008;18(10):1257-62.

Aydin MT, Aras O, Karip B, Memisoglu K. Staple line reinforcement methods in laparoscopic sleeve gastrectomy: comparison of burst pressures and leaks. J Society Laparoendoscopic Surgeons. 2015;19(3).






Original Research Articles