Reinforcing the staple line during laparoscopic sleeve gastrectomy: does it have advantages? A meta-analysis.

BACKGROUND This study aims to identify whether reinforcing the staple line during laparoscopic sleeve gastrectomy (LSG) has advantages. METHODS We searched MEDLINE (PubMed; till August 2011), EMBASE (till August 2011), and the Cochrane Central Register of Controlled Trials (Central) in the Cochrane Library (till August 2011) using common keywords related to sleeve gastrectomy and reinforcement. The keywords were as follows: "sleeve gastrectomy" and "reinforcement," or "reinforcing," or "reinforce," or "leak," or "leakage," or "staple," or "stapling," or "oversew," or "oversewing," or "oversewed." The language of publication was limited to English only. RESULTS Of the 358 articles meeting our initial criteria, eight full texts (two randomized control trial [RCT] and six cohort studies), involving 1,345 participants (828 patient cases and 517 controls) were included in the final analysis. Comparing the reinforcement of the staple line to no reinforcement of the staple line, the odds ratio (OR) for overall complications was 0.521 (95 % confidence intervals [CI], 0.349-0.777). In addition, the OR for staple line leak was 0.425 (95 % CI, 0.226-0.799) and for staple line hemorrhage was 0.559 (95 % CI, 0.247-1.266). CONCLUSION The current study showed that reinforcing the staple line during LSG has the following advantages: decreased incidence of postoperative leak and overall complications. More prospective studies with better evidence are needed.