Staple-Line Reinforcement with Bovine Pericardium in Laparoscopic Sleeve Gastrectomy: Experimental Comparative Study in Pigs

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Abstract

Background

We studied the usefulness of Bovine Pericardial strips (BPS) as a buttress in the prevention of complications from the gastric staple-line in laparoscopic sleeve gastrectomy (LSG).

Methods

LSG was carried out in 18 pigs. Resection of the stomach was performed with 4.8-mm/ 30-mm linear stapler eitherwithout(Control Group - n = 9) orwithBPS (Buttress Group - n = 9). Intra- and postoperative blood losses were assessed. Leaks were evaluated with methylene blue test intra-operatively and then clinically. The animals were sacrificed 2 weeks after surgery and the abdominal cavity was evaluated for fluid collections and adhesions, and the burst pressure of the stomach was measured and histopathological study of the staple-line was performed. Studentt-test was used for statistical analysis.

Results

No leaks were detected except for one small subclinical leak in the buttress group. Internal ulcers at the staple-line were seen more frequently in the Buttress group (6 vs. 3, not significant). There was no significant difference between the two groups with regards to operative time (65.3 ± 14.2 min, 69.7 ± 12.8 min), intra-operative bleeding (9.6 ± 2.2 ml, 8.2 ± 1.5 ml), postoperative hemoglobin levels (11.3 ± 1.9 g%, 11.8 ± 2.2 g%), and burst pressure (152.6 ± 23.5 mmHg, 161.2 ± 15.8 mmHg) for the Control and Buttress groups respectively. More intense adhesions and inflammatory response were observed in the Buttress Group.

Conclusions

In this experimental model, the use of bovine pericardium as a staple-line buttress in LSG was easy and safe; however, it did not decrease the occurrence of complications.

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