The effect of prophylactic intraoperative tranexamic acid use on bleeding after laparoscopic sleeve gastrectomy with omentopexy: a prospective cohort study

Background Laparoscopic sleeve gastrectomy (LSG) is the most widely performed bariatric procedure. While advancements like staple line reinforcement (SLR) have reduced hemorrhagic complications, bleeding risks persist. Tranexamic acid (TXA), an antifibrinolytic agent, has shown promise in mitigating bleeding risks in various surgical disciplines, but its efficacy in LSG with SLR remains unexplored. This study aims to evaluate the effect of intraoperative TXA administration on postoperative bleeding outcomes in patients undergoing LSG with oversewing and omentopexy.Methods This prospective observational cohort study included 233 patients undergoing LSG with oversewing and omentopexy. Patients were divided into 2 groups: 1 received 1 g of TXA intraoperatively, while the other did not. Hemoglobin differences at 24 and 48 hours postoperatively were the primary outcomes. Secondary outcomes included blood transfusion necessity, re-intervention rates, and 30-day surgical complications.Results There was no statistically significant difference in hemoglobin changes at 24 hours (TXA group: 0.8 +/- 0.7 g/dL, 95% CI: 0.67-0.93; control group: 0.9 +/- 0.9 g/dL, 95% CI: 0.74-1.06; P = 0.125) or at 48 hours (TXA group: 1.4 +/- 1.5 g/dL, 95% CI: 1.12-1.68; control group: 1.5 +/- 1.4 g/dL, 95% CI: 1.25-1.75; P = 0.167) between the groups. No patients required transfusions or re-interventions. Five patients in the control group exhibited hemorrhagic drainage exceeding 150 mL, while none in the TXA group experienced similar complications. Length of hospital stay and operative time were similar between the groups (P = 0.124 and 0.746, respectively).Conclusions Tranexamic acid may not significantly impact major bleeding complications following LSG with oversewing and omentopexy but appears to reduce minor hemorrhagic events.