DISCUSSION
bleeding, tissue slippage, postoperative bleeding, colorectal and pancreatic surgeries, Bleeding, tissue damage, malformation
BLEEDING, VASCULARIZATION, POSTOPERATIVE BLEEDING, LEAKAGE, BLEEDING, SEPARATION, COMPLICATIONS
Surgical staplers are commonly used in various surgical procedures to facilitate
rapid and effortless tissue division and closure. Its use in bariatric surgery is
considered the gold standard. Studies have shown that the use of reinforcing
products on the stapling line is beneficial.Research showing the beneficial results of waiting for a certain amount of time
before stapling is limited.In our study, staple line bleeding was observed in 17 (14.1%) patients, with 12
patients in T0 and 5 patients in T1, respectively. These results indicate that the
current rate is higher than that previously reported in the literature. We believe
that this is due to our comprehensive assessment, which included variables that we
believe were associated with bleeding and broad in scope. Two patients in the
non-waiting group underwent transfusion because of bleeding, and the other patients
were managed conservatively. Better bleeding outcomes were achieved in T1. This can
be attributed to the compression–wait–firing–wait–separation technique used, which
compresses the tissue to obtain a flatter and thinner tissue, reduces staple
slippage from the tissue during firing, and promotes optimal staple formation.Intraluminal bleeding cannot be observed intraoperatively prior to endoscopic
inspection after staple firing. Bleeding at the staple line may indicate bleeding
within the lumen of an organ or structure.Major postoperative morbidity after LSG is often associated with staple line leakage,
which has two main causes: ischemic or mechanical and technical aspects related to
incorrect firing of the stapler and the type of cartridge used.During the postoperative follow-up, 22 patients (18.6% of the total patients) had
complications within the first 30 days after surgery. The type and frequency of
these complications were similar to those reported in previous research studies.In a limited number of studies on distal pancreatectomy, a waiting time of 10 min has
been shown to reduce tissue slippage as the staple legs penetrate the tissue,
resulting in proper tissue compression and a smooth staple line by allowing fluid drainage.The effects of tissue precompression have been determined in limited studies related
to colorectal and pancreatic surgeries.Overall, these findings highlight that stapling techniques should be considered in
bariatric surgery to minimize postoperative bleeding and improve patient
outcomes.This study had some limitations. First, although stapler malformation is believed to
be the primary cause of bleeding and leakage, whether optimal stapler formation is
associated with improved clinical outcomes remains unclear. Second, the potential
effects of precompression on the gastric wall, such as vascularization, bleeding,
and tissue damage, were not evaluated. However, these factors are critical and
require further investigation. Last, the lack of studies with longer dwell times
limits the ability to compare and determine the most effective dwell time.