Self-locking first stitch in suture reinforcement of the laparoscopic gastric sleeve

摘要

Dear Editor, The laparoscopic gastric sleeve (LGS) is currently one of the most preferred bariatric surgeries worldwide mainly because of its low morbidity and mortality rates; effectiveness in the medium term; excellent resolution of comorbidities, including type 2 diabetes mellitus; lack of predisposition to marginal ulceration, internal hernia, or nutritional deficiencies; facilitation of full endoscopic examination of the stomach postoperatively; short operation and hospitalization times; and easy revision or conversion to a Roux-en-Y gastric bypass. In a previous publication in Obesity Surgery, we demonstrated that with careful attention to surgical technique, the LGS can significantly reduce the frequency of postoperative symptoms of gastroesophageal reflux disease and achieve very low morbidity. A recent review of the literature found that reinforcing the staple line with a buttress during the LGS decreases the incidence of postoperative leaks and overall complications. A prospective randomized study showed no differences in terms of bleeding and postoperative leakage rates between oversewing and buttressing of the staple line in the LGS. We believe that reinforcing the staple line could prevent leaks related to ischemia or staple line failure; assist in hemostasis; correct irregularities in the shape of the sleeve, reducing areas of dilatation; and reduce the probability of adhesions in cases of revisions. Approximately 50 % of surgeons oversew the staple line. There is no definitive proof, however, that this maneuver prevents complications.