Clipping versus Suturing in Prevention of Staple Line Bleeding in Laparoscopic Sleeve Gastrectomy

Abstract Background: Laparoscopic Sleeve Gastrectomy (LSG) has evolved rapidly as a single stage procedure for patients with morbidobesity and now itrepresents the most famous bariatric operation in the world with favourable therapeutic results and low risk complications. Leakage and bleeding represent the main postoperative complications. Although postoperative leakage is a major concern for bariatric surgeons, staple line bleeding (SLB) still represents an important issue that needs more focus and special attention as its incidence is between 0-10%. Aim of Study: We aim to compare between clipping and suturing the staple line and its impact on staple line bleeding primarily and other complications secondary. Material and Methods: It’s retrospective study on 410 patients, divided into 2 groups; group A: 220 patients under-went clipping of the suture line, group B: 190 patients under-went suturing. The primary outcome variable was post-operative bleeding (POB). Other outcome variables included hospitalisation period, complications, readmission and mor-tality within 30 days. Results: No significant difference between both groups as regard preoperative data. The operative time was signifi-cantly different between both; in the clipping group it ranged from 22-50min, in the suturing group from 30-60min. Also the blood loss from the staple line was significantly different; in the clipping group: 50-200cc, suturing group 70-250cc. Number of cases with POB was significantly different being more in the suturing group (12 cases=6.3%). Leakage and other complications were insignificantly different, however leakage occurred in three cases in the clipping group and one in the other. Conclusion: We assume that clipping achieve better bleeding control with much less operative time but may carry a little more risk of leakage. We look forward to do wider studies comparing with combined use of both, how and where to use each.