Comparison of Laparoscopic Sleeve Gastrectomy Staple Line Reinforcement Techniques: Buttressing vs. Suturing

Abstract

Background: Laparoscopic sleeve gastrectomy (LSG) is a widely performed bariatric procedure, with staple line reinforcement techniques playing a crucial role in minimizing complications. This study aimed to compare the outcomes of two common reinforcement methods—Gore SeamGuard® buttressing and suturing—used during LSG at King Fahad General Hospital, Jeddah, Saudi Arabia, between 2021 and 2024.
Methods: A retrospective analysis was conducted using the medical records of 347 patients who underwent LSG. Patients were divided into two groups based on the reinforcement method used: buttressing (n=120) and suturing (n=227). Demographic details, comorbidities, intraoperative data (operative time, blood loss), and postoperative complications (staple line leakage, bleeding, surgical site infections) were collected. Statistical analysis included chi-square tests for categorical variables and t-tests for continuous variables, with significance set at p<0.05.
Results: The mean body mass index (BMI) was significantly higher in the buttressing group (44.05 ± 5.99) compared to the suturing group (41.51 ± 6.26) (p<0.001). The prevalence of diabetes mellitus was also higher in the buttressing group (28.3% vs. 12.3%, p<0.001). The mean operative time was shorter for the buttressing group (73.42 ± 18.48 minutes) compared to the suturing group (90.55 ± 13.75 minutes) (p<0.001). Staple line leakage occurred only in the suturing group (3.1%, p=0.05). Other complications, including intraoperative and postoperative bleeding, surgical site infections, and reoperation rates, showed no significant differences between groups. No 30-day mortality was reported in either group.
Conclusion: Buttressing with Gore SeamGuard® demonstrated advantages over suturing, including a shorter operative time and the absence of staple line leakage, suggesting improved procedural efficiency and safety. However, the higher prevalence of comorbidities in the buttressing group may have influenced these findings. Both techniques were generally safe, with minimal complications and no mortality. Further prospective studies are recommended to confirm these results and explore the long-term implications of reinforcement methods in LSG.