الفهرس 
Introduction and rationaleOnly 14 pages are availabe for public view
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Abstract
Overweight and obesity are major public health problems. A person with a body mass index (BMI) ≥ 25 is considered as overweight while a person with a BMI of ≥ 30 is generally considered as obese. Therapeutic interventions for the treatment of obesity range from lifestyle and diet modifications to pharmacologic and surgical therapy. Currently, bariatric surgery had proven to be the most effective and durable option for weight loss in morbidly obese patients. One of the options of bariatric surgery is laparoscopic sleeve gastrectomy (LSG). Staple line leak and bleeding are the most dangerous complications of LSG. Various methods for staple line reinforcement (SLR) by oversewing the staple line or buttressing the staple line with various synthetic and biological materials were suggested to reduce the incidence of leak and bleeding. The techniques of oversewing include invagination of the staple line with continuous seromuscular lembert sutures or placing full thickness through and through sutures around the staple line; through and through sutures have shown increased rates of leak.
A randomized controlled clinical trial that included 50 morbidly obese patients with BMI of ≥ 40 kg/m2 or patients with a BMI of ≥ 35 kg/m2 with comorbid diseases at department of surgery at Suez Canal university hospitals. The study participants were assigned in two groups(by simple random method: i) group A: patients who underwent laparoscopic sleeve gastrectomy with staple line reinforcement and ii) group B: patients who underwent laparoscopic sleeve gastrectomy without staple line reinforcement.
Summary
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Our results showed there is no statistically significant difference between patients in reinforcement group and no reinforcement group in regard to postoperative bleeding or leakage. Moreover, there is no statistically significant difference between patients in reinforcement group and no reinforcement group regarding hospital stay. On the other hand, there is a statistically significant reduction in BMI and EWL between preoperative and postoperative at 1, 3 and 6 months. However, there was no statistically significant difference between the two groups at any time interval.
This study had some limitations, in which we are aware that the studied groups were small, a potential cause of bias. A larger number of patients would have produced stronger support for the claim that leaks may be unavoidable, even with reinforcement, but we should emphasize that the leak rate after LSG has been decreasing as experience with the technique has increased. Most surgeons prefer to use reinforcement along the staple line, and some have described proper technique and suitable stapler sizes. Further randomized controlled studies with larger sample size would be of great value to provide support for the result.
In conclusion,