Warm Saline Irrigation Reduces Early Postoperative Bleeding Following Laparoscopic Sleeve GastrectomyTrial shows warm saline irrigation reduces surgical bleeding risk

BMC surgery Published June 20, 2026 Study authors: Abdalla Gamal M, Farrag Ahmed M, Halim George M PubMed ↗ NCT07475169 ↗ DOI ↗ Editorial oversight: Dr. Ji-eun Park, MD · Brain, Mind & Pain

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Key Takeaway

Warm saline irrigation significantly reduces early bleeding events and drain volume after laparoscopic sleeve gastrectomy.

This randomized controlled trial evaluated the impact of temperature on surgical site hemostasis in 200 adults undergoing laparoscopic sleeve gastrectomy. Patients were randomized to receive either warm saline irrigation (37-40°C) or conventional room-temperature irrigation (22-24°C) specifically at the staple line before omentopexy.

The primary outcome was a composite of early postoperative bleeding, including clinical bleeding, significant hemoglobin drops, and high drain output. Results showed a significantly lower incidence of this composite endpoint in the warm irrigation cohort (5% vs 15%, p=0.02).

Secondary outcomes further supported the efficacy of thermal management. Patients receiving warm saline experienced significantly lower mean drain volumes (82 mL vs 128 mL) and smaller drops in hemoglobin levels compared to those receiving room-temperature irrigation. Additionally, patients reported modestly lower pain scores at the 24-hour mark.

While these findings suggest that warm irrigation improves early postoperative outcomes, the study's composite primary endpoint requires careful interpretation. Further large-scale multicenter trials are necessary to confirm these results and specifically evaluate the incidence of rare major complications.

Researchers conducted a randomized controlled trial involving 200 adults undergoing primary laparoscopic sleeve gastrectomy (LSG). The study compared the use of warm saline irrigation (37-40°C) along the staple line before omentopexy against standard room-temperature irrigation (22-24°C).

The results showed that patients who received warm saline had a much lower rate of early postoperative bleeding—5% compared to 15% in the room-temperature group. Additionally, those receiving warm irrigation had significantly lower drain volumes (82 mL vs. 128 mL) and smaller drops in hemoglobin levels (1.28 g/dL vs. 2.06 g/dL). Patients also reported modestly lower pain scores at the 24-hour mark.

While these results suggest that warm irrigation may improve safety and comfort during surgery, the study had some limitations. The primary outcome was a composite measure, and the sample size was too small to confirm if it prevents rare, major complications. Patients should discuss these findings with their surgical team to understand how this technique might apply to their specific procedure.

What this means for you:

Warm saline irrigation may reduce early bleeding and drain volume after gastric sleeve surgery.

Common questions

What are the benefits of using warm saline during surgery?

Using warm saline (37-40°C) instead of room-temperature liquid was linked to a lower rate of early postoperative bleeding, dropping from 15% down to 5%. It also resulted in significantly lower drain volumes and smaller drops in hemoglobin levels for the patients.

Does warm saline irrigation affect pain levels?

Patients who received warm saline irrigation reported modestly lower pain scores at the 24-hour mark following their surgery compared to those who received standard room-temperature irrigation. This suggests a potential for improved comfort in the early recovery period.

Is this technique safe for all patients?

The study included 200 adults and showed positive outcomes for bleeding and drainage. However, because the sample size was limited regarding rare complications, you should talk to your surgeon about how these specific findings apply to your personal health and surgical plan.

Study Details

Study typeRct

EvidenceLevel 2

PublishedJun 2026

PMID42304298

TrialNCT07475169

View Original Abstract ↓

BACKGROUND: Early bleeding remains a common concern after laparoscopic sleeve gastrectomy (LSG), despite improvements in stapling technology and reinforcement techniques. This study examined whether using warm saline to irrigate the staple line before performing omentopexy could enhance intra-operative hemostasis and reduce early postoperative bleeding. METHODS: In this prospective randomized trial conducted between December 2024 and June 2025, 200 adults undergoing primary LSG were allocated equally to warm saline irrigation (37-40 °C) or conventional room-temperature irrigation (22-24 °C), reflecting two clinically relevant intraoperative strategies in routine laparoscopic practice. Irrigation was applied directly to the staple line, followed by complete suctioning, careful inspection, and standardized omentopexy using 2-0 PDS sutures spaced 2 cm apart. The primary endpoint was a 48-h composite of early postoperative bleeding, defined as clinical bleeding, need for endoscopic or surgical control, hemoglobin drop (ΔHb) ≥ 2 g/dL on postoperative day 1, or drain output ≥ 150 mL in the first 24 h. Secondary outcomes included hemostasis time, ΔHb, drain volume, pain scores, postoperative nausea and vomiting (PONV), length of stay (LOS), and 30-day complications. This trial was powered for a composite bleeding endpoint rather than rare major bleeding events. RESULTS: Baseline characteristics were similar between groups. The composite bleeding endpoint occurred in 5% of patients receiving warm irrigation versus 15% in the control group (p = 0.02). Warm irrigation also resulted in lower drain output (82 ± 31 vs 128 ± 46 mL; p < 0.001) and a smaller ΔHb drop (1.28 ± 0.52 vs 2.06 ± 0.61 g/dL; p < 0.001). Pain scores were modestly lower at 24 h. LOS, PONV, readmission rates, and leak rates were comparable. CONCLUSION: Warm saline irrigation may improve hemostasis and early bleeding-related outcomes after LSG. However, given the composite nature of the primary endpoint and the limited sample size for rare complications, these findings should be interpreted cautiously, and larger multicenter studies are needed for confirmation. TRIAL REGISTRATION: ClinicalTrials.gov (NCT07475169), retrospectively registered on 12 February 2026.

Warm Saline Irrigation Reduces Early Postoperative Bleeding Following Laparoscopic Sleeve GastrectomyTrial shows warm saline irrigation reduces surgical bleeding risk

Common questions

Study Details

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Warm Saline Irrigation Reduces Early Postoperative Bleeding Following Laparoscopic Sleeve GastrectomyTrial shows warm saline irrigation reduces surgical bleeding risk

Common questions

Study Details

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