Publication: Laparoskopik sleeve gastrektomi ameliyatında stapler hattı güçlendirme tekniklerinin postoperatif erken dönem sonuçları ve gastrointestinal semptomlar üzerine etkisi / The effect of staple line reinforcement techniques in laparoscopic sleeve gastrectomy on the postoperative early results and gastrointestinal symptoms
Objective: In this study we aimed to compare the effects and relationships of staple line reinforcement methods on postoperative early complications and gastrointestinal symptoms prospectively in patients undergoing laparoscopic sleeve gastrectomy (LSG) due to morbid obesity. Materials and Methods: Our study included morbidly obese 90 patients undergoing LSG between June 2019 and February 2020 in Bezmialem Vakıf University Faculty of Medicine, Department of General Surgery. Approval was obtained from Bezmialem Vakıf University Clinical Research Ethics Committee for the study. According to the staple line reinforcement (SLR) techniques, 3 groups were determined as group - 1: using fibrin sealant (Tisseel®), group - 2:omentopexy and group - 3: no SLR and each group has 30 patiens and these groups were randomized by using www.random.org. Demographic findings such as age, gender, comorbid diseases, anticoagulant drugs used, body mass index, preoperative ultrasound and esophagoscopy findings were recorded. For detecting bleeding as a postoperative complication complete blood count was obtained and recorded from all patients preoperatively, postoperatively at sixth and 24th hours along with daily drainage flow rate three days consecutively. On the second day postoperative all patients underwent gastroduodenal passage swallow study to check if there is a leakage. Gastrointestinal symptoms (abdominal pain, indigestion, gastroesophagial reflux, constipation and diarrhea) were assessed by performing gastrointestinal symptom rating scale (GSRS) in all patients at following first week and 1st month. Results: 17 (18.9%) of patients were male and 73 (81.1%) of them were female, with a mean age of 35,3±11,6 years and mean BMI of 45,3±7,7 kg/m2. We detected concomitant diseases associated with obesity in 57 (63.3%) of patients (type 2 diabetes in n = 46 (51.1%), hypertension in n = 21 (23.3%), hyperlipidemia was found in n = 10 (11.1%), obstructive sleep apnea syndrome (OSAS) in n = 10 (11.1%) and anticoagulant medication in n = 7 (7.8%)) respectively. When the demograpic data of the groups and their comorbidities were compared, no statistically significant difference was found and it was determined that the groups were homogeneously distributed. Mortality was not observed in any group. Operation time of the groups; 83.6 ± 17.7 minutes for group 1, 85.4 ± 16.2 minutes for group 2. and 70.7 ± 11.9 min for group 3. recorded as. When the operation times were compared, group 3 was found to be statistically significantly shorter than the other groups (for group 1 (p = 0.005), group 2 (p = 0.001)). Mean hospital stay was 3.2 ± 0.5 days. All patients gave blood sample at 6th hour (mean Hgb:12.95±2,95 g/dL, p=0.582) and 24th hour (mean Hgb:12.04±2,45 g/dL p=0,261) after surgery for hemoglobin value, there was no statistically significant difference between groups. When postoperative 1st day (p = 0,193), 2nd day (p = 0,233) and 3rd day (p = 0,363) drain flow rates were compared between the groups, no statistically significant difference was observed. In group 3, 2 (2.2%) patients had bleeding. No leakage was observed in any patient. According to the results of the GSRS questionnaire, in group 3 reflux and indigestion symptom scores were significantly higher than groups 1 and 2 (p <0.001). With regarding to abdominal pain scoring there was no statistical difference between the groups at the first week postoperatively. Conclusion: Today, there is controversy about the routine use of staple line reinforcement (SLR) techniques in sleeve gastrectomy surgery. Our study is the first prospective randomized clinical study investigating the effects of SLR methods on the gastrointestinal system in LSG. We found that the use of SLR methods reduces gastrointestinal system complaints in the early postoperative period. In our study, the SLR methods in LSG did not show a statistically significant difference on postoperative early complications. However, it was determined that the use of SLR clinically decreases the complication rates. For better and powerful results; there is a need for new comparative studies involving larger patient groups evaluating medium and long term results.