Reinforcing the staple line with Surgicel® Nu-knit® in Roux-en-Y gastric bypass: comparison with bovine pericardial strips.

BACKGROUND: In the literature, staple line leak rate is reported to be 1-6 %, and hemorrhage rate is 2-5 % in laparoscopic Roux-en-Y gastric bypass (LRYGB). Various buttress materials are available in an attempt to reduce perioperative complications. The aims of our study are to evaluate the effect of using absorbable hemostat (SNK) as buttress material and compare its usage with bovine pericardial strips (PSD).

METHODS: Between January 2006 to May 2007 and from October 2007 to December 2009, a total of 1,074 patients underwent LRYGB at our institution. Of these 1,074 patients, PSD was used in 443 (41.2 %) patients, and SNK was used in 631 (58.8 %) patients. A retrospective review of a prospectively collected database was performed for all LRYGB patients, noting the outcomes and complications of the procedure.

RESULTS: Five (1.1 %) patients required transfusion of packed red blood cells (PRBC) during early postoperative period (postoperative 1-3 days) in the PSD group, while two (0.3 %) patients required transfusion in the SNK group. SNK patients received significantly lower mean units of PRBC (1.0 unit) when compared to that of PSD patients (5.0 units). One (0.2 %) anastomotic leak was found in the PSD group on postoperative day (POD) 10. One (0.2 %) patient in the SNK group also showed an anastomotic leak on POD 2. Additionally, the cost of SNK per procedure was significantly less than that of PSD.

CONCLUSIONS: The use of absorbable hemostat as buttress material may be effective in reducing acute postoperative bleeding in LRYGB at a significantly lower cost.