Kasr El Aini Journal of Surgery VOL., 13, NO 3 September 2012 37 A Prospective Randomized Study of the Effect of Staple Line Reinforcement in Laparoscopic Sleeve Gastrectomy A. Ayad MD*, M. Hassan MD *, K. Hosny MD *, W. Tobar MD * * Surgery Department, Kasr El Aini, Cairo University ABSTRACT Sleeve gastrectomy is a surgical technique to treat morbid obesity, by both restrictive and hormonal action, by reducing Ghrelin which is responsible for appetite .It is secreted by the fundus of the stomach which is totally removed in the procedure. Originally developed as a first stage to gastric bypass, it is more and more performed as a sole procedure. The purpose of this study was to determine if staple-line reinforcement, with a continuous inverting stitch, reduces surgical complications, and to report results on weight loss and reduction in co-morbidity. This was a prospective comparative study of all patients who underwent laparoscopic sleeve gastrectomy in an 18 month period .Patients were enrolled in group A if they received staple –line reinforcement, and in group B when not. Parameters were operative variables, complications, weight loss and the need for medication for co-morbidity .A total of 51 patients with a median age of 34 years (range 25-44), and with a median preoperative BMI of 44.8 kg/ m² (range=36.2- 58.7), underwent laparoscopic sleeve gastrectomy, 26 patients were enrolled in group A with reinforcement of the staple line, and 25 in group B without. The median operative time was 65 min, and median hospital stay 3 days.2 cases had leakage and another 2 were opened in group B 1 case had his Ryle stapled to the stomach in group A. The median follow up was 12 months (range 1- 24 )The median percentage of excess weight loss was 34.7%, and the median loss in BMI points was 22.5%, 66% of the patients were able to diminish or stop their medications for diabetes, hypertension, and hyperlipedemia Key words: Laparoscopic sleeve gastrectomy, Staple-line reinforcement and Complications. INTRODUCTION Laparoscopic sleeve gastrectomy as a stand alone procedure has been reported on since 2004 (1) . Prior to this sleeve gastrectomy was performed as part of the duodenal switch bypass procedure, where sleeve gastrectomy was initially performed with a view to coming back later after initial weight loss, to complete the duodenal switch component (2) . Surgeons found that often the duodenal switch component was not necessary due to the excellent weight loss after laparoscopic sleeve gastrectomy alone (3) . Studies reported a weight loss after laparoscopic sleeve gastrectomy ranging from 35% to 72% at 6 months and 51% to 83% at 12 months (4) Some institutions support sleeve gastrectomy as a first step in high risk patients, and in those with a high BMI, with the aim of performing a second final procedure after weight loss. On the other hand, other teams , such as that led by Akkary consider it as an alternative to adjustable gastric banding, gastric bypass, or biliopancreatic diversion (5) The purpose of this study was to determine whether staple line reinforcement would reduce the surgical complications of laparoscopic sleeve gastrectomy, and the evaluation of sleeve gastrectomy as a procedure and its effect on weight loss and co- morbidity. PATIENTS & METHODS Over the period of 2 years from December 2009 to December 2011, fifty one patients presenting with morbid obesity to the outpatient clinic in kasr el aini hospital , were divided into two groups. The first group(A) included 26 patients aged from 25 to 44 years average (33) years, 22 females and 4 males .The second group (B) included 25 patients whose age ranged from 27 to 42 years average 35 years, 18 females and 7 males . After admittance to the study , the patients were randomized by the ward nurse by closed envelopes into two groups undergoing laparoscopic sleeve gastrectomy, Group (A) who received staple line reinforcement and group (B)