A Narrative of Intraoperative Staple Line Leaks and Bleeds During Bariatric Surgery

The primary objective of this review was to assess the incidence of intraoperative staple line leaks and bleeds during laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). A literature search of MEDLINE®, EMBASE™, and Biosis from January 2010 to November 2014, plus secondary citations extending to 2008, identified 16 relevant articles. For LSG, the incidence of intraoperative leaks and bleeds was as high as 3.93 and 4.07 %, respectively. For LRYGB, leaks occurred in up to 8.26 % and bleeds in 3.45 % of cases. Stapler misfire was commonly cited as a cause. Widespread, precautionary use of staple line reinforcement (SLR), lack of standardized testing, and underreporting suggest the incidence may be underestimated. Published studies were insufficient to address the economic impact of bleeds and leaks or interventions, but development of improved stapler designs that obviate the need for SLR may reduce costs and improve outcomes.