Impact of Staple Line Oversewing on the Rate and Severity of Postoperative Complications and Intraoperative Events After Sleeve Gastrectomy: A Retrospective Study of 2,391 Patients.

BACKGROUND

Staple line complications following laparoscopic sleeve gastrectomy (LSG) remain a significant source of perioperative morbidity. While reinforcement strategies have been proposed to reduce these events, evidence regarding their true benefit remains inconsistent. This study evaluates the impact of systematic staple line oversewing on intraoperative and postoperative outcomes using standardized classification systems.

METHODS

Retrospective cohort study of 2,391 patients undergoing primary LSG at a single center (2014-2025), divided into non-reinforced (NSG, n = 583) and reinforced (RSG, n = 1,808) groups. Postoperative complications were classified by Clavien-Dindo and intraoperative events by ClassIntra. Multivariate binary logistic regression identified independent predictors of complications.

RESULTS

Overall postoperative complication rates were significantly lower in the RSG group (3.21% vs. 7.20%, p < 0.001), with significant reductions in Clavien-Dindo grade I and IIIB events. Intraoperative adverse events (ClassIntra ≥ 1) were not independently associated with postoperative complications (OR 1.037, p = 0.906), and the protective effect of staple line reinforcement persisted after their inclusion in the model (OR 0.419, 95% CI 0.273-0.643, p < 0.001). Female sex was independently protective (OR 0.585, p = 0.016), while hypertension was the sole independent risk factor (OR 1.623, p = 0.036).

CONCLUSIONS

Systematic staple line oversewing during LSG is independently associated with a 58.3% reduction in postoperative complication odds, irrespective of patient demographics, metabolic profile, or surgical history. These findings support its routine adoption, particularly during early program development.