The last stapler dilemma in Laparoscopic Sleeve Gastrectomy

Kanokkan Tepmalai, MD, Warit Utanwutipong, MD, Ajjana Techagumpuch, MD, Mahadevan D. Tata, MD, Suthep Udomsawaengsup, MD, Suppa-ut Pungpapong, MD, Chadin Tharavej, MD, Patpong Navicharern, MD

Chula Minimally invasive Surgery Center, Department of surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand 10330.

Introduction: Laparoscopic Sleeve Gastrectomy (LSG) has increased in number over the past decade. This procedure involves removal the greater curvature of the stomach by using stapling devices. The dilemma after firing of the last stapler is when the tissue is not completely cut even though the staplers line totally covered the tissue. The surgeons have to decide whether to use another stapler or just cut in between the stapler bridge. Aim: to measure the minimal length of the stapler needed beyond the tissue edge to be considered safe.

Methods: Excised gastric specimens from LSG were used. The stapling devices were fired at the fundic area in various distance of stapler covering beyond the tissue edge. The staple line forming and bridging tissue length were recorded. The leaks were tested by infused normal saline solution with blue dye in stomach lumen.

Results: Total of 20 stomach specimens were used in this experiment. 18 staples were fired. Mean threshold leak volume of saline solution was 1140 ml. The mean leak pressure was 23.02 cmH2O. Complete separation of stomach tissue was obtained by placing the stapler at distance 10 mm beyond the tissue edge. When the stapler go beyond tissue less than 3 mm. Bridging tissue did not safely cut by metzenbaum and high leakage risk.

Conclusions: Assiduous technique during placement of the final stapler in LSG can minimize the complication due to leaking.

Session: Poster Presentation

Program Number: P390

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