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Gastric Wall Thickness and Linear Staple Height in Sleeve Gastrectomy in Japanese Patients with Obesity

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Laparoscopic sleeve gastrectomy (LSG) is a standard procedure due to its low complication rates and favorable outcomes. However, limited data are available regarding the optimal size of linear staplers in relation to gastric wall thickness (GWT).


Between August 2016 and December 2020, we performed LSG in 70 patients with an average age, body weight, and body mass index of 42 years, 107 kg, and 40 kg/m2, respectively. We measured the GWT at the antrum, body, and fundus using resected specimens. We used an endo-linear stapler, and the closed staple height (CSH) was 1.75 mm.


We found that the average GWT at the antrum was significantly thicker than the GWT at the body and fundus. There was a statistically significant relationship between body weight and the GWT at the antrum and body and obstructive sleep apnea and the GWT at the body. The average CSH/GWT ratios were 0.55, 0.62, and 0.90 at the antrum, body, and fundus, respectively. However, in 20 patients (29%), the CSH/GWT ratio at the fundus area was ≥ 1.0, and only preoperative body weight was a significant predictor for a CSH/GWT ratio of ≥ 1.0.


A light body weight may be related to a CSH/GWT ratio of ≥ 1.0 at the fundus.

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  1. Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc. 2006;20:859–63.

    Article  CAS  PubMed  Google Scholar 

  2. Bohdjalian A, Langer FB, Shakeri-Leidenmühler S, et al. Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg. 2010;20:535–40.

    Article  PubMed  Google Scholar 

  3. Felberbauer FX, Langer F, Shakeri-Manesch S, et al. Laparoscopic sleeve gastrectomy as an isolated bariatric procedure: intermediate-term results from a large series in three Austrian centers. Obes Surg. 2008;18:814–8.

    Article  PubMed  Google Scholar 

  4. Ohta M, Kasama K, Sasaki A, et al. Japan Consortium of Obesity and Metabolic Surgery (JCOMS) Current status of laparoscopic bariatric/metabolic surgery in Japan: the sixth nationwide survey by the Japan Consortium of Obesity and Metabolic Surgery. Asian J Endosc Surg. 2021;14(2):170–7.

    Article  PubMed  Google Scholar 

  5. Brethauer S, Chand B, Schauer P. Risks and benefits of bariatric surgery: current evidence. Cleve Clin J Med. 2006;73:993–1007.

    Article  PubMed  Google Scholar 

  6. Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26:1509–15.

    Article  PubMed  Google Scholar 

  7. Boeker C, Mall J, Reetz C, et al. Laparoscopic sleeve gastrectomy: investigation of fundus wall thickness and staple height-an observational cohort study: fundus wall thickness and leaks. Obes Surg. 2017;27(12):3209–14.

    Article  PubMed  Google Scholar 

  8. Elariny H, Gonzalez H, Wang B. Tissue thickness of human stomach measured on excised gastric specimens from obese patients. Surg Technol Int. 2005;14:119–24.

    PubMed  Google Scholar 

  9. Rawlins L, Rawlins M, Teel D. Human tissue thickness measurements from excised sleeve gastrectomy specimens. Surg Endosc. 2014;28:811–4.

    Article  PubMed  Google Scholar 

  10. Van Rutte PW, Naagen BJ, Spek M, et al. Gastric wall thickness in sleeve gastrectomy patients: thickness variation of the gastric wall. Surg Technol Int. 2015;27:123–8.

    PubMed  Google Scholar 

  11. Huang R, Gagner M. A thickness calibration device is needed to determine staple height and avoid leaks in laparoscopic sleeve gastrectomy. Obes Surg. 2015;25:2360–7.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Abu-Ghanem Y, Meydan C, Segev L, et al. Gastric wall thickness and the choice of linear staples in laparoscopic sleeve gastrectomy: challenging conventional concepts. Obes Surg. 2017;27:837–43.

    Article  PubMed  Google Scholar 

  13. Lee YJ, Kim YN, Park S. Measurement of stomach wall thickness to guide staple selection during sleeve gastrectomy. Obes Surg. 2020;30(6):2140–6.

    Article  PubMed  Google Scholar 

  14. Brethauer SA, Kim J, el Chaar M, et al. Standardized outcomes reporting in metabolic and bariatric surgery. Surg Obes Relat Dis. 2015;11(3):489–506.

    Article  PubMed  Google Scholar 

  15. ASMBS Clinical Issues Committee. Peri-operative management of obstructive sleep apnea. Surg Obes Relat Dis. 2012;8(3):e27-32.

    Article  Google Scholar 

  16. Lundell LR, Dent J, Bennett JR, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45:172–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Endo Y, Ohta M, Tada K, et al. Improvement of non-alcoholic fatty liver disease after laparoscopic sleeve gastrectomy in Japanese obese patients. Ann Gastroenterol Surg. 2019;3:285–90.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Ohta M, Kai S, Iwashita Y, et al. Initial experience in laparoscopic sleeve gastrectomy for Japanese morbid obesity. Asian J Endosc Surg. 2009;2:68–72.

    Article  Google Scholar 

  19. [Internet]. GIA™ Reloads with Tri-Staple™ technology [cited 2014 Nov 10]/. Available from:

  20. Fricker M, Goggins BJ, Mateer S, et al. Chronic cigarette smoke exposure induces systemic hypoxia that drives intestinal dysfunction. JCI Insight. 2018;3(3):e94040.

    Article  PubMed Central  Google Scholar 

  21. Yazar FM, Baykara M, Karaağaç M, et al. The role of conventional ultrasonography in the evaluation of antrum wall thickness in obese patients. Obes Surg. 2016;26:2995–3000.

    Article  PubMed  Google Scholar 

  22. Pickhardt PJ, Asher DB. Wall thickening of the gastric antrum as a normal finding: multidetector CT with cadaveric comparison. AJR Am J Roentgenol. 2003;181:973–9.

    Article  PubMed  Google Scholar 

  23. Stroh C, Kockerling F, Volker L, et al. Obesity Surgery Working Group, Competence Network Obesity. Results of more than 11,800 sleeve gastrectomies: data analysis of the German Bariatric Surgery Registry. Ann Surg. 2016;263:949–55.

    Article  PubMed  Google Scholar 

  24. Rosenthal R, International Sleeve Gastrectomy Expert Panel. International Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12, 000 cases. Surg Obes Relat Dis. 2012;8:8–19.

    Article  PubMed  Google Scholar 

  25. Kawasaki K, Fujino Y, Kanemitsu K, et al. Experimental evaluation of the mechanical strength of stapling techniques. Surg Endosc. 2007;21(10):1796–9.

    Article  PubMed  Google Scholar 

  26. Wang H, Li P, Du T, et al. Effects of increasing levels of defatted rice bran on intestinal physical barrier and bacteria in finishing pigs. Animals (Basel). 2019;9(12):1039.

    Article  Google Scholar 

  27. Redlich J, Souffrant WB, Laplace JP, et al. Morphometry of the small intestine in pigs with ileo-rectal anastomosis. Can J Vet Res. 1997;61(1):21–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Baker RS, Foote J, Kemmeter P, et al. The science of stapling and leaks. Obes Surg. 2004;14:1290–8.

    Article  PubMed  Google Scholar 

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Correspondence to Yuichi Endo.

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Ethics Approval

All procedures performed in studies involving human participants complied with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study has been approved by the Ethics Committee of Oita University Hospital (# 1900).

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All participants included in the study provided written informed consent.

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Key Points

GWT at the antrum was significantly thicker than that at the body and fundus.

GWT at the antrum and body statistically correlated with body weight.

Preoperative body weight was a predictor for the CSH/GWT ratio of ≥ 1.0 at the fundus

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Endo, Y., Ohta, M., Kawamura, M. et al. Gastric Wall Thickness and Linear Staple Height in Sleeve Gastrectomy in Japanese Patients with Obesity. OBES SURG 32, 349–354 (2022).

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