Stapler Misfire During Sleeve Gastrectomy: Caution With Buttress Use

David Nguyen, MD, Bahar Moheban, Amir Mehran, MD. UCLA Department of Surgery


Introduction: The use of staple line buttressing during vertical sleeve gastrectomy (VSG)has been advocated by some authors as a method to reduce the incidence of bleeding, leak, or strictures. The surgical literature, however, does contain reports of complications attributed to their use. We reviewed our experience with buttressed sleeve gastrectomies to identify such cases.

Methods and materials: Retrospective review of a prospectively collected IRB approved database of bariatric surgery cases performed at our institution.

Results: From 2006-9, 182 VSG cases were peformed. Six cases were identified where the stapler misfired due to buttress use, requiring additional sutured staple line repair. There were no long term consequences. A horizontally embedded staple at the ‘crotch’ was identified as the culprit. No further misfires were noted once that area was routinely divided with endoscissors

Conclusion: Whereas staple line reinforcement with buttress material is generally safe, surgeons should be aware of possible stapler misfiring  due to their use. Slow firing and careful monitoring of the surgical field will help identify the problem rapidly and avoid major consequences.

Session Number: Poster – Poster Presentations
Program Number: P423
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