Laparoscopic clips can be a safe buttressing method for the sleeve gastrectomy operations: An experimental study on resected sleeve gastrectomy specimens: Buttressing method for the sleeve gastrectomy

Abdulkadir Ünsal; Alper  Yavuz; Altan  Aydın; Hakan Buluş

doi:10.28982/josam.7419

Authors

Abdulkadir Ünsal Department of General Surgery, University of Medical Sciences, Ataturk Sanatoryum Training and Research Hospital, Ankara, Turkey https://orcid.org/0000-0002-7989-4232
Alper Yavuz Department of General Surgery, University of Medical Sciences, Ataturk Sanatoryum Training and Research Hospital, Ankara, Turkey https://orcid.org/0000-0003-1250-5914
Altan Aydın Department of General Surgery, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey https://orcid.org/0000-0002-2981-2833
Hakan Buluş Department of General Surgery, University of Medical Sciences, Ataturk Sanatoryum Training and Research Hospital, Ankara, Turkey https://orcid.org/0000-0001-5093-4993

DOI:

https://doi.org/10.28982/josam.7419

Keywords:

Obesity, Sleeve gastrectomy, Leakage

Abstract

Background/Aim: Laparoscopic sleeve gastrectomy has been accepted in obesity surgery, as it provides rapid weight loss and has low mortality rates. However, because of the long staple line, leakage is a significant problem for these patients. Buttressing methods can be used to reduce the leakage. The aim of this study was to evaluate the efficacy of clips for buttressing the staple line on resected sleeve gastrectomy patients.
Methods: The study included 20 patients aged 18–60 years who underwent laparoscopic sleeve gastrectomy surgery in our clinic. Any patients with connective tissue disease or with the removed stomach tissue not intact were excluded from the study. The age, gender, height, weight, and additional disease data were recorded. A manual manometer and inflation mechanism was created, and when the pressure suddenly dropped and a bubble was observed from the staple line, this value was recorded as the leakage pressure. By measuring the leakage pressure in the staple line by inflating the resected and removed stomach, leakage pressure and leakage location were recorded as no-clip leakage pressure. Then, the observed area of leakage was buttressed with laparoscopic clips, and the leakage pressure was measured once more by inflating the stomach; this value was recorded as the clipped leakage pressure.

Results: The first pressure value observed had a mean of 43.8mmHg (range, 35–55 mmHg); after application of the clips, the mean was 43.8 mmHg (range (40–50 mmHg) (P = 0.20). The leakage was located in the upper section in 14 (70%) cases, in the mid-section in 5 (25%) cases, and in the lower section in 1 (5%) case. Micro-leakage was observed in 15 (75%) cases, 1-mm leakage in 1 (5%) case, 2-mm leakage in 2 (10%) cases, and 3-mm leakage in 2 (10%) cases.

Conclusion: Leakage is the most significant complication following sleeve gastrectomy surgery. The use of laparoscopic clips was described as a buttressing method, but no positive effect of metal clips on leakage pressure was observed in our study. Clarification of the effect of the buttressing with metallic clips is required using in vivo and ex vivo experiments.

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