Staple Line Reinforcing During Laparoscopic Sleeve Gastrectomy: Comparison of Through and Through vs. Lembert’s Oversewing Methods: Single Center Experience

Abstract Backgrounds: The most serious stapler line complications (SLC) following laparoscopic sleeve gastrectomy (LSG) are bleeding and stapler line leakage (SLL). Various oversewing methods are used that reduce SLC by reinforcing the staple line (SLR): Through and Through (TaT) or Lembert suturing. In this retrospective study, we compared the effects of the Lemberts and TaT suturing on SLC incidence. Methods: A total of 586 patients were included in the study. These patients were divided into two groups: TaT (n=386) and Lemberts (n=200). The primary endpoints were SLL and bleeding. Secondary endpoints included postoperative complications, Clavien-Dindo Grade ≥3 complications, operative time, oversewing time, length of hospital stay, and mortality. Results: Operative time was longer in the TaT suturing method (p<0.001), while oversewing time was longer in the Lemberts suturing method (p<0.001). The incidence of bleeding and SLL was significantly lower with Lembert's suturing method (p=0.01, p=0.04; respectively). All postoperative complications, Clavien-Dindo Grade ≥3 complications and length of hospital stay were more seen in the TaT suturing method (p=0.002, p=0.02, p<0.001; respectively ). The incidence of blood transfusions, intensive care unit stay, and readmission rates were similar between the two methods. Conclusion: Compared to the TaT suturing method, the Lemberts suturing method was associated with a reduction in postoperative bleeding, SLL, all postoperative complications, Clavien-Dindo Grade ≥3 complications, and length of hospital stay, without causing a major difference in oversewing and total operative time. No differences were found between the two methods in terms of blood transfusion, intensive care unit stay, or mortality.