EXPERT COMMENTARY MAJOR FINDINGS
This article addresses one of the main issues in performing the LSG procedure—how to avoid leaks. This is important because leaks tend to be difficult to manage and are associated with increased morbidity and mortality. One option for surgeons is the use of staple line reinforcement as presented in this article. The authors conducted a retrospective review of 116 patients who underwent LSG performed with line reinforcement and showed to a zero-percent leak rate in consecutive sleeve procedures. This study and others reinforce the notion that staple line reinforcement can be used in LSG procedures with positive outcomes.
LIMITATIONS
This was not a randomized study; therefore, it is important to note there are other factors that affect patient outcomes, especially regarding leaks. This study also included a small number of patients. Since this was a retrospective and not an observational study, and is
limited to one institution, the findings should be read as such and we cannot make randomized, generalized conclusions.
WHY IS THIS STUDY IMPORTANT TO THE FIELD?
This article presents an important topic to the surgical community performing the LSG procedure— preventing incidences of leaks and bleeding. While much research, including this study, has found that the use of staple line reinforcement decreases the incidence of bleeding, the jury is still out on its effectiveness in reducing leaks. Although data are being published supporting that staple line reinforcement is effective, more randomized studies with a larger number of participants should be
undertaken to further explore this topic.
WHAT SHOULD YOU DO WITH THESE DATA AND THESE FINDINGS?
I am a big proponent of
reinforcing the staple line in one way or another. Personally, I advocate oversewing, but the use of buttressing material is another option. Although there is no strong concluding evidence, surgeons should seriously consider some form of reinforcement while performing a LSG, as this article points to the fact that staple line reinforcement is helpful.
GEORGE EID, MD, FACS Associate Professor of Surgery, University of Pittsburgh/UPMC Department of Surgery, Pittsburgh, Pennsylvania
June 2012 • Supplement • Bariatric Times 21S