Surgical Endoscopy

, Volume 22, Issue 8, pp 1894–1898 | Cite as

Bipolar sealing increases mesenteric reach during bowel transection compared with stapled division: clinical evidence and laboratory support in a porcine model

Article

Abstract

Background

The ideal technique for mesenteric division to create tension-free anastomoses has not been defined. For patients undergoing Roux-en-Y gastric bypass (RYGB), the mesenteric division technique was changed from stapler to bipolar sealing using LigaSure for cost reasons. This study aimed objectively to assess the impact of the mesenteric division method on mobilization length of the Roux limb in an animal model. Clinical complications related to Roux limb tension also were analyzed in the authors’ population of RYGB patients.

Methods

Bowel and mesenteric divisions were performed in a porcine model. Four pigs received six to eight mesenteric divisions each. Steady force was applied for 1 min. The distances between the divided limbs of bowel were compared. To assess the clinical impact with RYGB patients, anastomotic complications were analyzed before and after incorporation of bipolar sealing in the authors’ practice.

Results

In the porcine model, the length of mesenteric stretch averaged 93.7 mm with stapled division and 109 mm with bipolar sealing (p = 0.021). From a laparoscopic RYGB population, 160 patients with stapled division were included, all of whom were at least 1 year beyond their surgery. The study analyzed 792 patients with bipolar sealing for leak or bleeding and included 479 bipolar sealed patients more than 1 year beyond their surgery for analysis of their strictures. No difference in bleeding or leaks was found between these groups. The stricture rate was significantly different, with seven strictures after stapled division (4.37%) compared with one stricture after bipolar sealing (0.2%; p = 0.001).

Conclusions

Bipolar sealing for mesenteric division is superior to stapling for optimization of enteric limb length at constant tension in a laboratory model. Clinical evidence supports this hypothesis with patients undergoing RYGB surgery by a decrease in the complications that can arise from Roux limb tension.

Keywords

Bowel Complications Digestive Gut Obesity Technical 

References

  1. 1.
    Bricker EM (1950) Symposium on clinical surgery: bladder substitution after pelvic evisceration. Surg Clin North Am 30:1511–1521PubMedGoogle Scholar
  2. 2.
    Parks AG, Nichols RJ (1978) Proctocolectomy without ileostomy for ulcerative colitis. BJM 2:85–88Google Scholar
  3. 3.
    Mason EE, Ito C (1969) Gastric bypass. Ann Surg 170:329–339PubMedCrossRefGoogle Scholar
  4. 4.
    Halsted WS (1887) Circular suture of the intestine: an experimental study. Am J Med Sci 94:436–461CrossRefGoogle Scholar
  5. 5.
    Gambee LP (1951) A single-layer open intestinal anastomosis applicable to small as well as large intestine. West J Surg Obstet Gynec 59:1–5Google Scholar
  6. 6.
    Beahrs OH (1967) Complications of colonic surgery. Surg Clin North Am 47:983–988Google Scholar
  7. 7.
    Sapala JA, Wood MH, Sapala MA et al (1997) Stapler division of the omentum and small bowel mesentery in morbidly obese patients undergoing gastric bypass surgery. Obes Surg 7:207–210PubMedCrossRefGoogle Scholar
  8. 8.
    Martel B, Blanc P, Malafosse M et al (2002) Comparative anatomical study of division of the ileocolic pedicle for mesenteric lengthening. Br J Surg 89:775–778PubMedCrossRefGoogle Scholar
  9. 9.
    Thirlby RC (1995) Optimizing results and techniques of mesenteric lengthening in ileal pouch-anal anastomosis. Am J Surg 169:499–502PubMedCrossRefGoogle Scholar
  10. 10.
    Goes RN, Nguyen P, Huang D et al (1995) Lengthening of the mesentery using the marginal vascular arcade of the right colon as the blood supply to the ileal pouch. Dis Colon Rectum 38:893–895PubMedCrossRefGoogle Scholar
  11. 11.
    Levine LA (1992) Stepladder incision technique for lengthening of bowel mesentery. J Urol 148:351–352PubMedGoogle Scholar
  12. 12.
    Burnstein MJ, Schoetz DJ Jr, Coller JA et al (1987) Technique of mesenteric lengthening in ileal reservoir-anal anastomosis. Dis Colon Rectum 30:863–866PubMedCrossRefGoogle Scholar
  13. 13.
    Leonardo C, Guaglianone S, De Carli P et al (2005) Laparoscopic nephrectomy using Ligasure system: preliminary experience. J Endourol 19:976–978PubMedCrossRefGoogle Scholar
  14. 14.
    Heniford BT, Matthews BD, Sing RF et al (2001) Initial results with an electrothermal bipolar vessel sealer. Surg Endosc 15:799–801PubMedCrossRefGoogle Scholar
  15. 15.
    Takada M, Ichihara T, Kuroda Y (2005) Comparative study of electrothermal bipolar vessel sealer and ultrasonic coagulation shears in laparoscopic colectomy. Surg Endosc 19:226–228PubMedCrossRefGoogle Scholar
  16. 16.
    Romano F, Caprotti R, Franciosi C et al (2003) The use of Ligasure during pediatric laparoscopic splenectomy: a preliminary report. Pediatr Surg Int 19:721–724PubMedCrossRefGoogle Scholar
  17. 17.
    Landman J, Kerbl K, Rehman J et al (2003) Evaluation of a vessel sealing system, bipolar electrosurgery, harmonic scalpel, titanium clips, endoscopic gastrointestinal anastomosis vascular staples and sutures for arterial and venous ligation in a porcine model. J Urol 169:697–700PubMedCrossRefGoogle Scholar
  18. 18.
    DeMaria E, Sugarman HJ, Kellum JM et al (2002) Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity. Ann Surg 235:640–647PubMedCrossRefGoogle Scholar
  19. 19.
    Podnos YD, Jimenez JC, Wilson SE et al (2003) Complications after laparoscopic gastric bypass: a review of 3,464 cases. Arch Surg 138:957–961PubMedCrossRefGoogle Scholar
  20. 20.
    Sandrasegaran K, Rajesh A, Lall C et al (2005) Gastrointestinal complications of bariatric Roux-en-Y gastric bypass surgery. Eur Radiol 15:254–262PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Department of SurgeryDuke University Medical CenterDurhamUSA

Personalised recommendations