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Rogue Staples: An Alarming Trend Observed Over The Past Two Years

Allan E Stolarski, MD, MS, Olga Beresneva, MD, Cullen Carter, MD, Luise Pernar, MD, Brian Carmine, MD, Donald Hess, MD. Boston University Medical Center

Introduction: Our objective is to raise awareness of complications arising from loose or improperly folded staples (“rogue staples”) that originated from a staple closure device that was appropriately fired.  Linear staplers are frequently used instruments across all disciplines of surgery and are highly relied upon tools to effectively complete operations in a safe, efficient, and reliable manner.

Methods and Procedures: At a busy urban tertiary care center from August 1st. 2016 until August 31st 2018 we observed seven cases of rogue staples causing bowel obstruction after several gastric bypasses and one appendectomy performed by various surgeons.  Demographic data collected include age, procedure, and identification of the involved staple loads.  Outcomes of interest include the number of days between the index surgery and presentation with obstruction, length of stay after representation, and the morbidity of observed patients. 

Results: Over a two-year period we have identified seven cases related to a rogue staple protruding beyond the staple line after correct closure technique was applied resulting in adhesion (3 patients; 43%) or hooking of nearby bowel (4 patients; 47%). All of these patients required return to the operating room, during which time six patients (86%) were found to have a small bowel obstruction, and one patient (14%) suffered from internal hernia.  The average time to representation was 8.57 days (range: 2-17 days).  The average length of stay after representation was 4.29 days (range: 1-9 days), indicating and increased use of hospital resources.

Conclusion: Over two years, we present a series of seven cases where an improperly formed staple from a linear stapler caused direct mechanical obstruction or adhesion formation.  These cases resulted in bowel obstruction or internal hernia in the early postoperative period requiring reoperation.  To our knowledge, this is the largest case series in the literature describing this early postoperative complication.  Due to our recent experiences following gastric bypass or appendectomy, general and bariatric surgeons should be aware of these potentially significant consequences of linear staplers.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 93698

Program Number: P120

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

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