The powered Echelon Flex Endopath Stapler (EFPE) leads to less postoperative hemorrhage following laparoscopic Roux-en-Y gastric bypass; evidence for an unanticipated benefit from the powered staple device.

Darrell P Doucette, MD, John J Kelly, MD, Donald R Czerniach, MD, Philip A Cohen, MD, Richard A Perugini, MD. UMass Memorial Medical Center.

Introduction/Background: Ethicon Endosurgery has introduced a powered endoscopic stapling device (Echelon Flex Powered Endopath-EFPE). The benefits of this device include ease of use for individuals with smaller hands, and minimization of movement of the device during the cutting-stapling process. We have subjectively noted an improvement in staple line hemostasis. We compared outcomes in laparoscopic Roux en Y gastric bypass (LRYGB) using the EFPE to the non-powered Echelon Flex Endopath (EFE) endomechanical stapler. Our hypothesis was that the mechanized device led to less bleeding.

Methods: We present a series of consecutive LRYGB procedures, starting three months prior to the transition to EFPE (group A) and continuing for three months after the transition (group B). Cases were carried out by four surgeons who were all well beyond their learning curve. The surgical technique did not change, except for the introduction of the EFPE. All information was prospectively entered into a database used for quality assessment. Data included demographics of patients, preoperative hematocrit (Hct), four hour postoperative Hct (4hr Hct), and post operative day one Hct (POD#1 Hct). We recorded number of blood products transfused.

Results: This series included 194 consecutive LRYGB. Group A and Group B were similar with regards to age, gender, and BMI. The decrease from the 4hr Hct to POD#1 Hct was greater in Group A than in Group B (1.7 + 1.3 vs 1.2 + 1.4, p = 0.02). In Group A, three of 96 patients required a total of 8 units of packed red blood cells, while in group B, one of 99 patients required a total of one unit of packed red blood cells (p = 0.36). The postoperative length of stay was the same in both groups.

Conclusion: The EPFE stapler appears to lead to lower decrease in Hct after LRYGB, as well as a trend towards lower requirements for blood transfusion. This data suggests that the EPFE does indeed lead to less staple line bleeding. Furthermore, this study affirms a benefit of prospectively acquired databases, which is to assess the utility of surgical devices or change in technique.

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