To oversew or not to oversew in robotic sleeve gastrectomy: a case against oversewing the staple line. 2021

Rena C Moon, and Andre F Teixeira, and Muhammad A Jawad
Orlando Health Weight Loss and Bariatric Surgery Institute, Orlando Health, 89 W Copeland Dr, 1st Floor, Orlando, FL, USA.

BACKGROUND The benefits of oversewing the staple lines during laparoscopic sleeve gastrectomy have been controversial. No study examined the benefit of oversewing the staple lines in robotic sleeve gastrectomy (RSG). This retrospective study aims to examine the difference in immediate postoperative complications, readmissions, reoperations, and emergency room visits between RSG patients with and without oversewn staple lines at a single, large-volume, bariatric center. METHODS A retrospective chart review was conducted on 623 patients who underwent RSG between November 1, 2017, and November 1, 2019. Of these, 316 had their staple line oversewn between November 1, 2017, and November 12, 2018, and 307 did not have their staple line oversewn between November 13, 2018, and November 1, 2019. RESULTS A total of 623 patients underwent RSG, of which 50.7% (n = 316) had their staple line oversewn. The mean length of hospital stay was similar between the two groups. However, the mean operative time was significantly longer in the "oversew" group than "no oversew" group by 7.4 minutes (p < 0.001). Readmission, reoperation, and intervention rates during the 30-day postoperative period were similar between the two groups. However, the percentage of patients requiring outpatient emergency room visits during the 30 days after RSG was significantly higher in the "oversew" group than that of the "no oversew" group. CONCLUSIONS No significant difference in major complications was found between RSG patients with and without oversewn staple lines. Oversewing of the staple line may be associated with increased emergency room visits.

UI MeSH Term Description Entries
D009767 Obesity, Morbid The condition of weighing two, three, or more times the ideal weight, so called because it is associated with many serious and life-threatening disorders. In the BODY MASS INDEX, morbid obesity is defined as having a BMI greater than 40.0 kg/m2. Morbid Obesity,Obesity, Severe,Morbid Obesities,Obesities, Morbid,Obesities, Severe,Severe Obesities,Severe Obesity
D010535 Laparoscopy A procedure in which a laparoscope (LAPAROSCOPES) is inserted through a small incision near the navel to examine the abdominal and pelvic organs in the PERITONEAL CAVITY. If appropriate, biopsy or surgery can be performed during laparoscopy. Celioscopy,Laparoscopic Surgical Procedures,Peritoneoscopy,Surgical Procedures, Laparoscopic,Laparoscopic Assisted Surgery,Laparoscopic Surgery,Laparoscopic Surgical Procedure,Procedure, Laparoscopic Surgical,Procedures, Laparoscopic Surgical,Surgery, Laparoscopic,Surgical Procedure, Laparoscopic,Celioscopies,Laparoscopic Assisted Surgeries,Laparoscopic Surgeries,Laparoscopies,Peritoneoscopies,Surgeries, Laparoscopic,Surgeries, Laparoscopic Assisted,Surgery, Laparoscopic Assisted
D005743 Gastrectomy Excision of the whole (total gastrectomy) or part (subtotal gastrectomy, partial gastrectomy, gastric resection) of the stomach. (Dorland, 28th ed) Gastrectomies
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D017792 Surgical Stapling A technique of closing incisions and wounds, or of joining and connecting tissues, in which staples are used as sutures. Stapling, Surgical,Staplings, Surgical,Surgical Staplings
D065287 Robotic Surgical Procedures Surgical procedures performed remotely using a computer that controls surgical instruments attached to mechanical arms designed to perform the tasks of the surgeon. Robot Surgery,Robot-Assisted Surgery,Robot-Enhanced Procedures,Robot-Enhanced Surgery,Robotic-Assisted Surgery,Surgical Procedures, Robotic,Procedure, Robot-Enhanced,Procedure, Robotic Surgical,Procedures, Robotic Surgical,Robot Assisted Surgery,Robot Enhanced Procedures,Robot Enhanced Surgery,Robot Surgeries,Robot-Assisted Surgeries,Robot-Enhanced Procedure,Robot-Enhanced Surgeries,Robotic Assisted Surgery,Robotic Surgical Procedure,Robotic-Assisted Surgeries,Surgery, Robot,Surgery, Robot-Assisted,Surgery, Robot-Enhanced,Surgery, Robotic-Assisted,Surgical Procedure, Robotic

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