Background: Staple line bleeding can be a major intraoperative complication during laparoscopic sleeve gastrectomy, requiring reinforcing interventions that may diminish the integrity of the staple line and put patients at risk for postoperative hemorrhage or leak. To improve outcomes associated with surgery, surgeons may benefit from an alternative stapler that produces a drier staple line and requires less staple line manipulation.Methods: Sixty consecutive laparoscopic sleeve gastrectomy procedures were performed by three surgeons; 30 sleeves using the AEON TM Endostapler on THICK MODE and 30 using the Echelon Flex TM Powered Stapler with pulse technique. Stapler performance was measured by incidence and degree of staple line bleeding. Images of the first firing and fundus were taken with the laparoscope 10 seconds after the final firing. Images were evaluated by a third-party blinded evaluator and given a "bleeding score," a qualitative measure of intra-operative staple-line bleeding (1 = no bleeding to 5 = profuse bleeding).
Results:The AEON TM Endostapler demonstrated a lower mean (6 standard error) "bleeding score" versus the Echelon Flex TM (2.1 6 0.1 vs. 2.6 6 0.1; p = 0.01). The AEON TM Endostapler had 15 cases (50%) with no bleeding at the fundus; the Echelon Flex TM had 7 cases (23%) with no bleeding at the fundus. The AEON TM Endostapler had 0 cases (0%) with profuse bleeding; the Echelon Flex TM had 2 cases (7%) with profuse bleeding.
Conclusion:The AEON TM Endostapler is a significantly drier alternative to the Echelon Flex TM Powered Stapler, producing a much drier staple line and decreasing the need for other bleeding control methods.
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