Ricerc@Sapienza

I read with great interest the excellent
article ‘‘The Impact of Different Surgical
Techniques on Outcomes in Laparoscopic
Sleeve Gastrectomies’’1 from Berger et al,
published in the September 2016 issue of
Annals of Surgery. The role of the impact
of different technical details on the outcome
of sleeve gastrectomies is particularly
relevant, and several aspects pointed out by
the authors certainly deserve the maximum
attention of the international bariatric
surgical community.
The set of data reported in the study is
impressive and very informative. However,
some concerns need to be raised because they
constitute excellent examples of the strength
and limitations of a data registry observational
retrospective study, even if large and very
well conducted.
One of the main conclusion of the
article is related to the increased risk of a
leak associated with buttressing. Certainly,
the authors clarify that the literature on staple
line reinforcement has conflicting results.
They also acknowledge the lack of specific
information about the buttressing products
used in their series. This limitation is, indeed,
very relevant as it has been shown that there
are significant differences between them.