Laparoscopic Sleeve Gastrectomy

Laparoscopic sleeve gastrectomy (LSG) was introduced into bariatric surgery as a first step approach followed by Roux-en-Y gastric bypass or biliopancreatic diversion with duodenal switch. The major complications of LSG in the early postoperative course are staple line bleeding and leakage. Bleeding from the staple line is the most common complication and exists in about 1.1–8.7% of cases. This cannot always be treated conservatively and may require reoperation. The most dangerous and life-threatening complication is staple line leakage, with the reported incidence ranging from 0.5% to 2.7%. Staple line reinforcement (SLR) has been proposed to decrease the risk of these complications. SLR can be achieved with several options: oversewing the staple line with a running absorbable suture, buttressing it with specific materials or roofing the staple line. Although it has been postulated that there are fewer complications, SLR remains controversial, and its effectiveness is still unclear.