ORIGINAL CONTRIBUTIONS Comparison Between Stable Line Reinforcement by Barbed Suture and Non-reinforcement in Sleeve Gastrectomy: a Randomized Prospective Controlled Study Mohamed Hany 1 & Mohammed Ibrahim 1 # Springer Science+Business Media, LLC, part of Springer Nature 2018 Abstract Introduction Laparoscopic sleeve gastrectomy (LSG) is now a popular bariatric procedure worldwide with rising prevalence over the last decade. Staple line leak and bleeding are the most dangerous complications of LSG. Staple line reinforcement (SLR) by oversewing the staple line was suggested to reduce the incidence of leak and bleeding. We designed a randomized controlled prospective study to investigate the value of SLR by invaginating the whole staple line using unidirectional absorbable 3/0 V-Loc 180 sutures (Covidien, Mansfield, MA, USA) to no SLR in LSG. Patients and Methods Nine hundred and twenty patients undergoing LSG between March 2016 and March 2017 were included in the study; they were prospectively randomized into two groups: A and B, each of 460 patients. In group A, the entire staple line was invaginated with continuous seromuscular suturing using 3/0 V-Loc 180 suture (Covidien, Mansfield, MA, USA), and in group B, no reinforcement was done. The patients were selected according to National Institute of Health (NIH) guidelines. All procedures were performed by the same team of experienced bariatric surgeons. Patients were followed up for 6 weeks after surgery for occurrence of complications. Results The two groups were matched considering the demographic data. Operative time was significantly longer in group A (P = 0.001), with mean operative time in group A was 69 min, while that in Group B was 50.8 min. Leak occurred in eight cases (1.7%) in group B and none (0%) in group A; leak was significantly lower in group A (P = 0.008). Bleeding occurred in two patients (0.4%) in group A and in seven (1.5%) in group B (P = 0.178), with no statistically significant difference between both groups as regards bleeding. Conclusion Comparing SLR by invaginating the whole staple line using unidirectional absorbable 3/0 V-Loc 180 sutures (Covidien, Mansfield, MA, USA) to no SLR in a relatively large cohort of patients undergoing LSG, in a randomized controlled prospective study, has proved statistically significant value for SLR by invaginating sutures. Keywords Sleeve gastrectomy . Stable line . Reinforcement . Bariatric surgery Introduction Laparoscopic sleeve gastrectomy (LSG) is now a popular bar- iatric procedure worldwide [1, 2], with rising prevalence over the last decade [3, 4]. LSG in 2013 was the second most commonly performed bariatric procedure (37%) worldwide after Roux-en-Y gastric bypass (45%) with a steep rise from 2003 to 2013 [5]. LSG in 2014 has been the most commonly performed bariatric procedure worldwide (45.9%) overcom- ing RYGB (39.6) [6]. The results of short-term and long-term follow-up after LSG show effective and durable weight loss together with reduction of comorbidities [4, 7, 8]. Initially, LSG was a part of the duodenal switch bariatric operation, and now, it is an approved standalone bariatric pro- cedure by the American Society of Metabolic and Bariatric Surgery (ASMBS) since 2010, with good short-term and long- term results [4, 7–9]. * Mohamed Hany dr.mhany@gmail.com 1 Department of Surgery, Medical Research Institute, Alexandria University, 165, Horreya Avenue, Hadara, Alexandria 21561, Egypt Obesity Surgery https://doi.org/10.1007/s11695-018-3175-2