Kalashnikov O. O.

RISK FACTORS FOR STAPLE LINE LEAK AFTER SLEEVE GASTRECTOMY

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About the author:

Kalashnikov O. O.

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CLINICAL AND EXPERIMENTAL MEDICINE

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Scientific article

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Staple line leak (SLL) is one of the most clinically significant complications of sleeve gastrectomy (SG), as it may require repeated surgical or endoscopic interventions, prolong treatment, and substantially affect the severity of the postoperative course. The development of SLL is multifactorial and may be related to patient characteristics as well as technical and intraoperative factors. Risk assessment is particularly important in revisional SG, which is performed in the setting of altered anatomy and previous upper gastrointestinal surgery. The aim of the study is to analyze potential risk factors for staple line leak after primary and revisional sleeve gastrectomy. A retrospective cohort study included 253 patients who underwent primary or revisional SG. Primary SG was performed in 242 patients and revisional SG in 11. The study endpoint was SLL, which occurred in 7 cases. Potential risk factors included age, sex, body mass index (BMI), operative time, intraoperative blood loss, visually detected bleeding from the staple line, the need for additional intraoperative hemostasis, and type of procedure (primary or revisional SG). Continuous variables were compared using the Mann–Whitney U test and categorical variables using the two-sided Fisher exact test. Associations with SLL were assessed using univariable binary logistic regression with calculation of odds ratios (ORs), 95% confidence intervals (CIs), and p values. Differences were considered statistically significant at p<0.05. SLL occurred in 5 of 242 patients after primary SG and in 2 of 11 patients after revisional SG. Among the analyzed factors, only revisional SG showed a statistically significant association with SLL. Univariable logistic regression demonstrated that revisional SG was associated with a 10.53-fold increase in the odds of SLL compared with primary SG (OR=10.533; 95% CI 1.795–61.825; p=0.009); the difference was also significant according to the two-sided Fisher exact test (p=0.032). No statistically significant associations with SLL were identified for age, sex, BMI, operative time, intraoperative blood loss, or visually detected staple line bleeding. The need for additional intraoperative hemostasis was associated with an increased point estimate of the odds of SLL (OR=3.981; 95% CI 0.857–18.486), but this association did not reach statistical significance (p=0.078). In the studied cohort, revisional SG was the only analyzed factor significantly associated with SLL. These findings support considering the revisional nature of the procedure in SLL risk stratification and surgical planning. However, the small absolute number of SLL events warrants cautious interpretation of the magnitude of the observed association.

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1. Brown WA, Liem R, Al-Sabah S, Anvari M, Boza C, Cohen RV, et al; IFSO Global Registry Collaboration. Metabolic bariatric surgery across the IFSO chapters: key insights on the baseline patient demographics, procedure types, and mortality from the eighth IFSO Global Registry Report. Obes Surg. 2024;34(5):1764-1777. DOI: https://doi.org/10.1007/s11695-024-07196-3
2. Iossa A, Martini L, De Angelis F, Micalizzi A, Watkins BM, Silecchia G, et al. Leaks after laparoscopic sleeve gastrectomy: 2024 update on risk factors. Langenbecks Arch Surg. 2024;409(1):249. DOI: https://doi.org/10.1007/s00423-024-03424-7
3. Spiro C, Bennet S, Bhatia K. Meta-analysis of patient risk factors associated with post-bariatric surgery leak. Obes Sci Pract. 2023;9(2):112-126. DOI: https://doi.org/10.1002/osp4.628
4. Osti N, Aboud A, Gumbs S, Sabbagh R, Carryl S, Nazir S, et al. Six-year analysis of 30-day post-operative leaks for primary sleeve gastrectomy: a MBSAQIP database study. Surg Endosc. 2024;38(12):7451-7458. DOI: https://doi.org/10.1007/s00464-024-11190-2
5. Shuchleib A, Swartz D, Talavea Piña J, Garcia Vences E, Mercado M. Predicting postoperative leaks: a preoperative risk index for bariatric surgery. Obes Surg. 2025;35(8):3190-3196. DOI: https://doi.org/10.1007/s11695-025-08030-0
6. Verras GI, Mulita F, Lampropoulos C, Kehagias D, Curwen O, Antzoulas A, et al. Risk factors and management approaches for staple line leaks following sleeve gastrectomy: a single-center retrospective study of 402 patients. J Pers Med. 2023;13(9):1422. DOI: https://doi.org/10.3390/jpm13091422
7. Ali AB, Morris LM, Hodges J, Amirkhosravi F, Yasrebi S, Khoo A, et al. Postoperative bleeding and leaks in sleeve gastrectomy are independent of both staple height and staple line oversewing. Surg Endosc. 2022;36(9):6924-6930. DOI: https://doi.org/10.1007/s00464-022-09031-1
8. Aiolfi A, Gagner M, Zappa MA, Lastraioli C, Lombardo F, Panizzo V, et al. Staple line reinforcement during laparoscopic sleeve gastrectomy: systematic review and network meta-analysis of randomized controlled trials. Obes Surg. 2022;32(5):1466-1478. DOI: https://doi.org/10.1007/s11695-022-05950-z
9. Diab ARF, Alfieri S, Doyle W, Koussayer B, Docimo S, Sujka JA, et al. Seamguard buttressing of the staple line during laparoscopic sleeve gastrectomy appears to decrease the incidence of postoperative bleeding, leaks, and reoperations: a systematic review and meta-analysis of non-randomized comparative studies. Obes Surg. 2023;33(7):2237-2245. DOI: https://doi.org/10.1007/s11695-023-06649-5
10. Diab ARF, Malaussena Z, Ahmed A, West W 3rd, Docimo S Jr, Sujka JA, et al. How does oversewing/suturing (OS/S) compare to other staple line reinforcement methods? A systematic review and meta-analysis. Obes Surg. 2024;34(3):985-996. DOI: https://doi.org/10.1007/s11695-024-07069-9
11. Niaz O, Askari A, Currie A, McGlone ER, Zakeri R, Khan O, et al. Analysis of the effect of staple line reinforcement on leaking and bleeding after sleeve gastrectomy from the UK National Bariatric Surgery Registry. World J Surg. 2024;48(8):1950-1957. DOI: https://doi.org/10.1002/wjs.12271
12. Ma L, Gao Z, Luo H, Kou S, Lei Y, Jia V, et al. Comparison of the postoperative outcome with and without intraoperative leak testing for sleeve gastrectomy: a systematic review and meta-analysis of 469 588 cases. Int J Surg. 2024;110(2):1196-1205. DOI: https://doi.org/10.1097/JS9.0000000000000919
13. Mohamedahmed AYY, Hamid M, Zaman S, Abdalla HE, Wuheb AA, Khan A, et al. Does omentopexy make a difference in laparoscopic sleeve gastrectomy for obesity treatment? A systematic review and meta-analysis. Obes Surg. 2024;34(1):218-235. DOI: https://doi.org/10.1007/s11695-023-06956-x
14. Xie Y, Zhu H, Gou Y, Yu X, Liu Y. Does the use of staple line reinforcement during sleeve gastrectomy and Roux-en-Y gastric bypass affect clinical outcomes? Systematic review and meta-analysis. Langenbecks Arch Surg. 2025;410(1):170. DOI: https://doi.org/10.1007/s00423-025-03750-4
15. Wisniowski P, Samakar K, Cheng V, Hawley L, Abel S, Nguyen J, et al. Safety of redo sleeve gastrectomy as a primary revisional procedure. Surg Obes Relat Dis. 2024;20(11):1084-1089. DOI: https://doi.org/10.1016/j.soard.2024.04.016
16. Brar K, Sudan R, Portenier D, Greenberg JA, Eckhouse SR, Seymour KA, et al. Postoperative outcomes following revision or conversion surgery after primary sleeve gastrectomy: an analysis of the MBSAQIP database. Surg Obes Relat Dis. 2025;21(8):956-964. DOI: https://doi.org/10.1016/j.soard.2025.04.003
17. Kermansaravi M, Parmar C, Chiappetta S, Shikora S, Aminian A, Abbas SI, et al. Best practice approach for redo-surgeries after sleeve gastrectomy, an expert’s modified Delphi consensus. Surg Endosc. 2023;37(3):1617-1628. DOI: https://doi.org/10.1007/s00464-023-09879-x
18. de Angelis F, Boru CE, Iossa A, Perotta N, Campanile FC, Silecchia G. Long-term outcomes of sleeve gastrectomy as a revisional procedure after failed gastric band: a multicenter cross-matched cohort study. Updates Surg. 2022;74(2):709-713. DOI: https://doi.org/10.1007/s13304-021-01182-5

Publication of the article:

«Bulletin of problems biology and medicine», 2026 Issue 3, 182, 282-288 pages, index UDC 616.33-089.87-06:616-056.52

DOI:

10.29254/2077-4214-2026-3-182-282-288