eISSN: 2299-0054
ISSN: 1895-4588
Videosurgery and Other Miniinvasive Techniques
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vol. 13
Original paper

More stapler firings increase the risk of perioperative morbidity after laparoscopic sleeve gastrectomy

Piotr Major, Michał Wysocki, Michał Pędziwiatr, Magdalena Pisarska, Piotr Małczak, Mateusz Wierdak, Marcin Dembiński, Marcin Migaczewski, Mateusz Rubinkiewicz, Andrzej Budzyński

Videosurgery Miniinv 2018; 13 (1): 88–94
Online publish date: 2017/09/26
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Staple-line bleeding and leakage are the most common serious complications of laparoscopic sleeve gastrectomy. The relationship between multiple stapler firings and higher risk of postoperative complications is well defined in colorectal surgery but has not been addressed in bariatric procedures so far. Identification of new factors such as “the numbers of stapler firings used during laparoscopic sleeve gastrectomy (LSG)” as a predictor for complications can lead to optimization of the patient care at bariatric centers.

To determine the association between perioperative morbidity and the number of stapler firings during laparoscopic sleeve gastrectomy.

Material and methods
This observational study was based on retrospective analysis of prospectively collected data in patients operated on for morbid obesity in a teaching hospital/tertiary referral center for general surgery. The patients who underwent LSG were analyzed in terms of the number of stapler firings used as a new potential risk predictor for postoperative complications after surgery, adjusting for other patient- and treatment-related factors. The study included 333 patients (209 women, 124 men, mean age: 40 ±11).

During the first 30 days after surgery, complications were observed in 18 (5.41%) patients. Multivariate analysis showed that prolonging operative time increased morbidity (every minute, OR = 1.01; 95% CI: 1.00–1.02) and the complication rate increased with the number of stapler firings (every firing, OR = 1.91; 95% CI: 1.09–3.33; p = 0.023).

Additional stapler firings above the usual number and a prolonged operation should alert a surgeon and the whole team about increased risk of postoperative complications.


sleeve gastrectomy, postoperative complications, risk factors, stapler firings

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