Laparoscopic Vertical Sleeve Gastrectomy: Technological Alternative for Staple Line Imbrication

Ricardo K Mohammed, DO, Olivier Van Houtte, MD, Gintaras Antanavicius, MD. Abington Jefferson Hospital


Laparoscopic vertical sleeve gastrectomy is one of the most commonly used bariatric procedures.  One of the dreaded complications associated with this procedure is a leak occurring at the staple line.  Staple line leaks occur in approximately 2.8% of cases, and can be due to a variety of reasons such as technique, poor vascularization and inflammation. Numerous modalities are available to reinforce the staple line in an attempt to prevent post-operative staple line leaks.

One technique which may decrease complications and provide reinforcement includes imbrication of the vertical sleeve gastrectomy staple line.  Imbrication has been shown to add strength to the staple line. While this may be technically challenging by free hand intracoporeal suturing, we employ the Endo360TM  device which allows the surgeon to perform intracorporeal suturing similar to the Endostitch TM.  Major advantages of this device include a sharp and curved needle on an instrument in which articulation is possible.  This is extra step may help to decrease complications associated with a vertical sleeve gastrectomy.



Endo360tm instrument with non-absorbable 2-0 suture is used for staple line imbrication.


Intracorporeal suturing by free hand can be technically challenging.  The Endo360tm device allows the surgeon to imbricate the vertical sleeve gastrectomy staple line and possibly decrease complications such as leaks.  Our video demonstrates the technique we employ while using this instrument.

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