Evaluation of three different techniques for staple line reinforcement in laparoscopic sleeve gastrectomy: a prospective randomized study

Background: Obesity is a major health problem worldwide, associated with numerous comorbidities. Laparoscopic sleeve gastrectomy (LSG) has emerged as one of the most effective bariatric procedures; however, staple line complications such as bleeding and leakage remain significant concerns. This study aimed to evaluate three different techniques of staple line reinforcement during LSG: full-thickness continuous over sewing, seromuscular suturing, and a combined method, regardingboth early and late postoperative outcomes. A prospective randomized study was conducted on patients undergoing LSG, who were allocated into three groups according to the reinforcement technique used. Intraoperative blood loss, hospital stay, and postoperative complications, mainly bleeding, leakage, and gastric twisting, were assessed, in addition to weight loss outcomes. Results: The results demonstrated that all three reinforcement methods were safe and effective in minimizing complications. Among them, the combined technique (group C) showed a statistically significant rise in both operative duration and blood loss when compared with groups A and B, with the over-sewing full-thickness continuous suturing technique (group A) exhibiting the least operative time and blood loss. Conclusion: Staple line reinforcement is an important step in reducing the risks of bleeding and leakage after LSG. The combined reinforcement technique may offer superior protection compared with single methods. Larger studies are recommended to confirm these findings.