Compression pre-stapler firing and post-ignition wait during sleeve gastrectomy: a prospective randomized trial
Palavras-chave:
Gastrectomy, Stapling, Hemorrhage, Surgical stapling, Bariatrics, Surgical staple, Morbid obesities, Bariatric surgeryResumo
BACKGROUND: Insufficient research exists on the stapling technique in and duration of laparoscopic sleeve gastrectomy (LSG).
OBJECTIVES: This study aimed to assess the clinical outcomes using a 30-second precompression and post-firing waiting time without extra support for the stapling line.
DESIGN AND SETTINGS: Randomized controlled prospective study at a university hospital.
METHODS: This study included 120 patients treated between January 2022 and February 2023. The patients were divided into the non-waiting group (T0) and waiting group (T1), each with 60 patients. Perioperative complications were analyzed using statistical tests.
RESULTS: The waiting group (T1) showed a significant reduction in the number of intraoperative bleeding points requiring intervention compared with the non-waiting group (T0) (81 versus 134, P < 0.05). In T0, postoperative C-reactive protein (CRP) levels increased (P < 0.05) and hemoglobin levels decreased significantly (P <0.05). The study recorded 22 postoperative complications, accounting for 18.3% of all cases during the 30-day postoperative period.
CONCLUSIONS: The study concluded that the 30 sec + 30 sec stapling technique reduces perioperative bleeding, length of stay, and serious complication rates and is practical and effective for LSG.
CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov with registration code NCT05703035; link: https://clinicaltrials.gov/ct2/show/NCT05703035.
Downloads
Referências
English WJ, DeMaria EJ, Brethauer SA, et al. American Society for Metabolic and Bariatric Surgery estimation of metabolic and bariatric procedures performed in the United States in 2016. Surg Obes Relat Dis. 2018;14(3):259-63. PMID: 29370995; https://doi.org/10.1016/j. soard.2017.12.013.
Ali M, El Chaar M, Ghiassi S, Rogers AM; American Society for Metabolic and Bariatric Surgery Clinical Issues Committee. American Society for Metabolic and Bariatric Surgery updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis. 2017;13(10):1652-7. PMID: 29054173; https://doi.org/10.1016/j. soard.2017.08.007.
Sarela AI, Dexter SPL, O’Kane M, Menon A, McMahon MJ. Long-term follow-up after laparoscopic sleeve gastrectomy: 8-9-year results. Surg Obes Relat Dis. 2012;8(6):679-84. PMID: 21890430; https://doi. org/10.1016/j.soard.2011.06.020.
Lin S, Li C, Guan W, Liang H. Can staple-line reinforcement eliminate the major early postoperative complications after sleeve gastrectomy? Asian J Surg. 2021;44(6):836-40. PMID: 33485768; https://doi.org/10.1016/j. asjsur.2020.12.036.
Torensma B, Hisham M, Eldawlatly AA, Hany M. Differences between the 2016 and 2022 editions of the Enhanced Recovery After Bariatric Surgery (ERABS) Guidelines: call to action of FAIR data and the creation of a global consortium of bariatric care and research. Obes Surg. 2022;32(8):2753-63. PMID: 35654929; https://doi.org/10.1007/s11695-022-06132-7.
Medtronic. EndoGIA™ Universal Staplers Product Support. Minneapolis, Medtronic; 2010. Available from: https://image.tigermedical.com/ Brochures/COVEGIAUSHORT-20180822033811750.pdf. Accessed in 2023 (Aug. 7).
Wichmann D, Scheble V, Fusco S, et al. Role of Rendezvous-Procedure in the Treatment of Complications after Laparoscopic Sleeve Gastrectomy. J Clin Med. 2021;10(23):5670. PMID: 34884372; https://doi.org/10.3390/ jcm10235670.
Manufacturer’s instruction for use by Ethicon Endo-Surgery Inc. Cincinnati, Johnson & Johnson; 2022. Available from: https://www. jnjmedtech.com/en-US/platform/surgical-staplers. Accessed in 2023 (Aug. 7).
Nakayama S, Hasegawa S, Nagayama S, et al. The importance of precompression time for secure stapling with a linear stapler. Surg Endosc. 2011;25(7):2382-6. PMID: 21184102; https://doi.org/10.1007/ s00464-010-1527-7.
Major P, Wysocki M, Pędziwiatr M, et al. More stapler firings increase the risk of perioperative morbidity after laparoscopic sleeve gastrectomy. Wideochir Inne Tech Maloinwazyjne. 2018;13(1):88-94. PMID: 29643964; https://doi.org/10.5114/wiitm.2017.70197.
Chekan E, Whelan RL, Feng AH. Device-tissue interactions: a collaborative communications system. Ann Surg Innov Res. 2013;7(1):10. PMID: 23895104; https://doi.org/10.1186/1750-1164-7-10.
Nakayama S, Hasegawa S, Hida K, Kawada K, Sakai Y. Obtaining secure stapling of a double stapling anastomosis. J Surg Res. 2015;193(2):652-7. PMID: 25277356; https://doi.org/10.1016/j.jss.2014.08.044.
Carniel EL, Frigo A, Fontanella CG, et al. A biomechanical approach to the analysis of methods and procedures of bariatric surgery. J Biomech. 2017;56:32-41. PMID: 28314563; https://doi.org/10.1016/j. jbiomech.2017.02.029.
Eckharter C, Heeren N, Mongelli F, et al. Partial staple line reinforcement with synthetic buttressing material in laparoscopic sleeve gastrectomy: a propensity score-matched analysis. Langenbecks Arch Surg. 2023;408(1):47. PMID: 36662323; https://doi.org/10.1007/s00423-02302796-6.
Chikamoto A, Hashimoto D, Ikuta Y, et al. Effects of the closing speed of stapler jaws on bovine pancreases. Surg Endosc. 2014;28(1):336-40. PMID: 23982653; https://doi.org/10.1007/s00464-013-3157-3.
Iossa A, Abdelgawad M, Watkins BM, Silecchia G. Leaks after laparoscopic sleeve gastrectomy: overview of pathogenesis and risk factors. Langenbecks Arch Surg. 2016;401(6):757-66. PMID: 27301373; https:// doi.org/10.1007/s00423-016-1464-6.
Park JY. Diagnosis and management of postoperative complications after sleeve gastrectomy. J Metab Bariatr Surg. 2022;11(1):1-12. PMID: 36685085; https://doi.org/10.17476/jmbs.2022.11.1.1.
Aminian A, Wilson R, Al-Kurd A, et al. Association of bariatric surgery with cancer risk and mortality in adults with obesity. JAMA. 2022;327(24):2423-33. PMID: 35657620; https://doi.org/10.1001/ jama.2022.9009.
Hirashita T, Ohta M, Yada K, et al. Effect of pre-firing compression on the prevention of pancreatic fistula in distal pancreatectomy. Am J Surg. 2018;216(3):506-10. PMID: 29606277; https://doi.org/10.1016/j. amjsurg.2018.03.023.
Rawlins L, Rawlins MP, Teel 2nd D. Human tissue thickness measurements from excised sleeve gastrectomy specimens. Surg Endosc. 2014;28(3):811-4. PMID: 24196553; https://doi.org/10.1007/ s00464-013-3264-1.
Matsumoto I, Kamei K, Satoi S, et al. Efficacy of the slow firing method using a reinforced triple-row stapler for preventing postoperative pancreatic fistula during laparoscopic distal pancreatectomy. Surg Today. 2022;52(2):260-7. PMID: 34322726; https://doi.org/10.1007/ s00595-021-02344-z.
Nakamura M, Ueda J, Kohno H, et al. Prolonged peri-firing compression with a linear stapler prevents pancreatic fistula in laparoscopic distal pancreatectomy. Surg Endosc. 2011;25(3):867-71. PMID: 20730447; https://doi.org/10.1007/s00464-010-1285-6.
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Copyright (c) 2025 São Paulo Medical Journal

Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.