Does Inadequate Weight Loss Following Bariatric Surgery Predict Staple-Line Failure? A Prospective Study

Background: This study was undertaken to determine if weight gain after gastroplasty corresponds with gastric staple-line failure. Methods: Over a 10-year period, 157 patients underwent gastric restrictive operations using 4-row staplers, and were prospectively evaluated at 1, 3, and 6 months, then yearly for 6 years thereafter. Patients who experienced weight gain or lost less than 10 lb (4.5 kg) of weight between visits while maintaining 30% or greater excess body weight, were evaluated for staple-line integrity with an upper gastrointestinal contrast study. Results: forty-three (27%) patients met the criteria for contrast study during follow-up. Fourteen (33%) of these patients experienced staple-line failure (9% of the entire population). Two-thirds of those patients with inadequate weight loss following surgery had intact staple-lines. Of those patients who had staple-line failure, male gender and reoperative gastric procedure were the most common characteristics. Of the staple-line breakdowns, 10% occurred after using 4-row TA-90 staplers and 6% following division and stapling with the GIA-80. Comorbidities and degree of failure did manifest as independent risk factors for staple-line failure. Conclusions: Inadequate weight loss following gastric restrictive procedures for morbid obesity does not accurately predict staple-line failure.