Background

While robotic sleeve gastrectomy (RSG) has gained popularity over time, the benefit of reinforcing the staple line in RSG have not been thoroughly studied. This study aims to evaluate the effects of staple line reinforcement used during RSG on complication rates, specifically on post-operative bleeding and leak rates.

Methods

A retrospective analysis of MBSAQIP data from 2015-2019 was conducted for patients undergoing primary RSG. Patients were divided into three groupsno reinforcement (NR), staple line reinforcement (SLR), and oversewing (OS). Descriptive analysis was performed, followed by inverse propensity weighting, in pairwise comparison of the three groups.

Results

Both SLR and OS groups exhibited significantly lower bleeding rates compared to the NR group. Univariate analysis demonstrated that SLR required fewer transfusions (0.47% vs 0.63%; p=0.0362) and had lower bleeding rate (0.62% vs 0.88%; p=0.0037) compared to NR. OS had similar results in transfusions (0.42% vs 0.63%; p=0.0432) and in bleeding rate (0.53% vs 0.88%; p=0.0033) compared to NR. Significance was maintained with inverse propensity weighting. SLR had fewer transfusions than the NR (0.46% vs 0.64%; p=0.0215) and reduced bleeding risk (0.62% vs 0.90%; p=0.002). OS had reduced bleeding risk compared to NR (0.54% vs 0.89%; p=0.007), however, the significance was not maintained for transfusion rate (0.42% vs 0.63%; p=0.0597). No significant differences were observed in staple line leaks across all groups.

Conclusions

This study demonstrates the benefits of utilizing SLR or oversewing in reducing bleeding rates in RSG. Therefore, SLR or OS should be considered to mitigate bleeding risks.