Abstract:

Laparoscopic gastrointestinal (GI) surgery often requires transection and reconstruction of the GI tract and division of vascular pedicles. Intraoperative staple line bleeding and postoperative GI hemorrhage are reported complications. Prevention of staple line bleeding includes oversewing of the staple line or more recently the use of staple line reinforcement sleeves as an adjunct on the stapler. The results of bioabsorbable glycolide copolymer sleeves (Seamguard, W.L. Gore & Associates, Inc., Flagstaff, AZ, USA) as staple line reinforcement during 44 laparoscopic GI operations were reviewed. The charts were analyzed retrospectively for demographics, quantity of staple line reinforcement material used, operative time, blood loss, intraoperative complications, postoperative bleeding or leak, and serial hemoglobin. The study group of 44 patients included 17 males and 27 females, with a median age of 44 years. The laparoscopic GI operations performed were laparoscopic cystgastrostomy (n=1), esophagus cancer staging (n=2), esophagectomy (n=2), colectomy (n=3), gastrectomy (n=5), appendectomy (n=9), and Roux-en-Y gastric bypass (n=22). The median number of staple line reinforcement sleeves used per operation was one for appendectomy and laparoscopic cancer staging, five for gastrectomy and esophagectomy, and seven for gastric bypass and colectomy. The mean blood loss was 86 +/- 22 mL. No intraoperative staple line disruptions occurred. Intraoperative staple line bleeding was minimal and few staple lines required oversewing. One patient developed GI hemorrhage on postoperative day five after being involved in a motor vehicle accident. The mean hemoglobin decreased from 13.9 +/- 1.6 g/dL at baseline to 12.6 +/-1.4 g/dL on the first postoperative day. No postoperative leaks or abscesses occurred. This study demonstrates that bioabsorbable glycolide copolymer staple line sleeves is safe and effective in prevention of intraoperative staple line bleeding and postoperative GI hemorrhage in 44 intra-abdominal GI operations.

Authors:

Ninh T. Nguyen, M.D., F.A.C.S.; Mario Longoria, M.D.; Sara Chalifoux, B.S., Samuel E. Wilson, M.D., F.A.C.S.

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