Does the use of staple line reinforcement during sleeve gastrectomy and Roux-en-Y gastric bypass affect ClinicalOutcomes?: Systematic review and Meta-analysis

Abstract

Aims: This study aims to compare the clinical outcomes of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) with and without the use of staple line reinforcement. Methods: Randomized controlled trials (RCTs) and case-control studies (CCSs) on staple line reinforcement during SG and RYGB were retrieved from Wanfang, China National Knowledge Infrastructure, Database for Chinese Technical Periodicals, Chinese Biological Medicine, PubMed, Web of Science, Embase, and Cochrane Library according to pre-established search strategies. Meta-analyses were conducted under random-effects model for the primary outcomes (postoperative bleeding and gastric leakage) and the secondary outcomes (gastroesophageal reflux disorder (GERD), post-operative nausea and vomiting (PONV), surgical site infection (SSI), reoperation, operative time (minutes), hospital length of stay (days) and mortality). Results were presented as standardized mean difference (SMD) or odds ratios (OR) with corresponding 95% confidence interval (CI) and P value. Besides, an online survey was conducted to investigate the discrepancies in the utilization of staple line reinforcement among surgeons worldwide performing SG and RYGB. Results: A total of 9 RCTs and 16 CCSs involving 369,403 participants met the inclusion criteria. Meta analysis revealed that SG/RYGB with the use of a staple line reinforcement resulted in a significant reduction in postoperative bleeding (OR = 0.50; 95% CI 0.33, 0.75) and gastric leakage (OR = 0.51; 95% CI 0.33, 0.78), as well as a reduction in surgical site infection, re-operation, PONV, and the length of hospital stay, whereas prolonging the operation time compared to those without the use of staple line reinforcement. No significant differences were identified in the GERD, gastric torsion rates, and mortality between SG/RYGB procedures with and without the use of staple line reinforcement. A total of 129 bariatric surgeons responded to the questionnaire, providing their opinions on the utilisation of staple line reinforcement during SG/RYGB. Most surgeons expressed support to the use of staple line reinforcement (87.27% for SG and 56.25% for RYGB). However, a significant proportion of surgeons (12.73% for SG and 43.75% for RYGB) opposed the use of staple line reinforcement, citing concerns that it might narrow the stomach cavity and prolong the operation time. Conclusion: The utilisation of staple line reinforcement during SG/RYGB was demonstrated to effectively reduce the incidence of postoperative bleeding, gastric leakage, and to improve the partial secondary outcomes in comparison to those without the use of staple line reinforcement, which suggests that staple line reinforcement may be useful during SG and RYGB.