Staple-line reinforcement in laparoscopic sleeve gastrectomy: Needful or excessive care?

Laparoscopic sleeve gastrectomy (LSG) has achieved high approval rates as stand-alone weight loss procedure in recent years. Its safety and effectiveness have been clearly established by numerous published studies. On the other hand, there has been great concern about complications related to the long staple line, mainly bleeding and leaks. Although this concern is universal among bariatric surgeons, strategies to prevent complications related to the staple line are not consensual. Accordingly, staple-line reinforcement methods have been widely proposed in an attempt to reduce the risk of these adverse events. However, nonreinforced but technically well-performed staple line can also be a very safe option, saving operative time and procedure-related costs. Therefore, the purpose of this narrative review is to discuss current options for minimizing the risk of staple line-related bleeding and leaks in LSG, focusing on technical issues and reinforcement methods.