Authors: Yasmin AbuGhanem Chanan Meydan Lior Segev Moshe Rubin Orit Blumenfeld Hadar Spivak
Publish Date: 2016/12/29
Volume: 27, Issue: 3, Pages: 837-843
Abstract
Little evidence is available on the choice of linear staple reloads in laparoscopic sleeve gastrectomy LSG Previous literature recommends matching closed staple height CSH to tissuethickness TT to avoid ischemia Our objective was to examine feasibility and safety of “tight” hemostatic CSH/TT 1 stapling and map the entire gastric wall TT in LSG patientsProspectively collected outcomes on 202 consecutive patients who underwent LSG with tight order of staples Ethicon Endosurgery in this order prepylorus—black CSH = 23 mm antrum—green CSH = 20 mm antrum/body—blue CSH = 15 mm and white CSH = 10 mm on the body and fundus Measurements of entire gastric wall TT were made on the first 100 patients’ gastric specimens with an electronicdogmatic indicatorStudy included 147 females and 55 males with a mean age of 415 ± 119 years and body mass index of 415 ± 38 kg/m2 Gastric wall measurements revealed mean CSH/TT ratio 1 decreasing from 07 ± 01 at prepylorus to 05 ± 01 at the fundus There were 31 mechanical failures mainly 68 at prepylorus—black reloads Postoperative bleeding occurred in 5 25 patients There were no leaks or clinical evidence of sleeve ischemia Stepwise regression analysis revealed that body mass index P 0001 hypertension P 001 and male gender P 0001 were associated with increased gastric TTOur study suggests that reloads with CSH/TT 1 in LSG including staples with CSH of 1 mm on body and fundus are safe The results challenge the concept that tight stapling cause’s ischemia Since tight reloads are designed to improve hemostasis their application could have clinical benefit
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