Staple-line reinforcement with bovine pericardium in laparoscopic sleeve gastrectomy: Experimental comparative study in pigs

Background: We studied the usefulness of Bovine Pericardial strips (BPS) as a buttress in the prevention of complications from the gastric staple-line in laparoscopic sleeve gastrectomy (LSG). Methods: LSG was carried out in 18 pigs. Resection of the stomach was performed with 4.8-mm/ 30-mm linear stapler either without (Control Group - n=9) or with BPS (Buttress Group - n=9). Intra- and postoperative blood losses were assessed. Leaks were evaluated with methylene blue test intra-operatively and then clinically. The animals were sacrificed 2 weeks after surgery and the abdominal cavity was evaluated for fluid collections and adhesions, and the burst pressure of the stomach was measured and histopathological study of the staple-line was performed. Student t-test was used for statistical analysis. Results: No leaks were detected except for one small subclinical leak in the buttress group. Internal ulcers at the staple-line were seen more frequently in the Buttress group (6 vs 3, not significant). There was no significant difference between the two groups with regards to operative time (65.3 +/- 14.2 min, 69.7 +/- 12.8 min), intra-operative bleeding (9.6 +/- 2.2 ml, 8.2 +/- 1.5 ml), postoperative hemoglobin levels (11.3 +/- 1.9 g%, 11.8 +/- 2.2 g%), and burst pressure (152.6 +/- 23.5 mmHg, 161.2 +/- 15.8 mmHg) for the Control and Buttress groups respectively. More intense adhesions and inflammatory response were observed in the Buttress Group. Conclusions: In this experimental model, the use of bovine pericardium as a staple-line buttress in LSG was easy and safe; however, it did not decrease the occurrence of complications.