Skip to main content
SpringerLink
Log in

Gastric Wall Thickness and the Choice of Linear Staples in Laparoscopic Sleeve Gastrectomy: Challenging Conventional Concepts

  • New Concept
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

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 tissue-thickness (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 patients.

Methods

Prospectively collected outcomes on 202 consecutive patients who underwent LSG with tight order of staples (Ethicon Endosurgery) in this order: pre-pylorus—black (CSH = 2.3 mm), antrum—green (CSH = 2.0 mm), antrum/body—blue (CSH = 1.5 mm), and white (CSH = 1.0 mm) on the body and fundus. Measurements of entire gastric wall TT were made on the first 100 patients’ gastric specimens with an electronic-dogmatic indicator.

Results

Study included 147 females and 55 males with a mean age of 41.5 ± 11.9 years and body mass index of 41.5 ± 3.8 kg/m2. Gastric wall measurements revealed mean CSH/TT ratio <1, decreasing from 0.7 ± 0.1 at pre-pylorus to 0.5 ± 0.1 at the fundus. There were 3.1% mechanical failures, mainly (68%) at pre-pylorus—black reloads. Post-operative bleeding occurred in 5 (2.5%) patients. There were no leaks or clinical evidence of sleeve ischemia. Stepwise regression analysis revealed that body mass index (P < 0.001), hypertension (P < 0.01), and male gender (P < 0.001) were associated with increased gastric TT.

Conclusions

Our 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

LSG:

Laparoscopic sleeve gastrectomy

TT:

Tissue thickness

CSH:

Closed staple height

BMI:

Body mass index

References

  1. Baker RS, Foote J, Kemmeter P, Brady R, Vroegop T, Serveld M. The science of stapling and leaks. Obes Surg. 14 10:1290–8. Jan.

  2. Chekan E, Whelan RL. Surgical stapling device-tissue interactions: what surgeons need to know to improve patient outcomes. Med Devices (Auckl). 2014;7:305–18.

    Article  PubMed Central  Google Scholar 

  3. Rawlins L, Rawlins MP, Teel D. Human tissue thickness measurements from excised sleeve gastrectomy specimens. Surg Endosc. 2014;28(3):811–4.

    Article  PubMed  Google Scholar 

  4. Bellanger DE, Greenway FL. Laparoscopic sleeve gastrectomy, 529 cases without a leak: short-term results and technical considerations. Obes Surg. 2011;21(2):146–50.

    Article  PubMed  Google Scholar 

  5. Sakran N, Assalia A, Sternberg A, et al. Smaller staple height for circular stapled gastrojejunostomy in laparoscopic gastric bypass: early results in 1,074 morbidly obese patients. Obes Surg. 2011;21(2):238–43.

    Article  PubMed  Google Scholar 

  6. 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(12):2360–7.

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  PubMed  Google Scholar 

  8. Sroka G, Milevski D, Shteinberg D, et al. Minimizing hemorrhagic complications in laparoscopic sleeve gastrectomy—a randomized controlled trial. Obes Surg. 2015;25(9):1577–83.

    Article  PubMed  Google Scholar 

  9. Bransen J, Gilissen LPL, van Rutte PWJ, et al. Costs of leaks and bleeding after sleeve gastrectomies. Obes Surg. 2015;25(10):1767–71.

    Article  PubMed  Google Scholar 

  10. Shikora SA, Mahoney CB. Clinical benefit of gastric staple line reinforcement (SLR) in gastrointestinal surgery: a meta-analysis. Obes Surg. 2015;25(7):1133–41.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Zellmer JD, Mathiason MA, Kallies KJ, et al. Is laparoscopic sleeve gastrectomy a lower risk bariatric procedure compared with laparoscopic Roux-en-Y gastric bypass? A meta-analysis. Am J Surg. 2014;208(6):903–10. discussion 909–10

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Tel HaShomer Medical Center, Ramat Gan, Israel

    Yasmin Abu-Ghanem, Chanan Meydan, Lior Segev, Moshe Rubin & Hadar Spivak

  2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Yasmin Abu-Ghanem, Chanan Meydan, Lior Segev, Moshe Rubin & Hadar Spivak

  3. Herzliya Medical Center, 7 Ramat Yam St, 4685107, Herzliya, Israel

    Moshe Rubin & Hadar Spivak

  4. Center for Disease Control, Ministry of Health, Jerusalem, Israel

    Orit Blumenfeld

Authors
  1. Yasmin Abu-Ghanem
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chanan Meydan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lior Segev
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Moshe Rubin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Orit Blumenfeld
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hadar Spivak
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hadar Spivak.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance 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.

Informed Consent

For this type of study, formal consent is not required.

Funding Sources

None.

Additional information

Yasmin Abu-Ghanem and Chanan Meydan had equal contribution to this article.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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 27, 837–843 (2017). https://doi.org/10.1007/s11695-016-2516-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-016-2516-2

Keywords

Search

Navigation