Improving Hemostasis in Sleeve Gastrectomy With Alternative Stapler

Redmann, James G; Lavin, Thomas; French, Matthew S.; Broussard, Toby D; Lapointe-Gagner, Maxime

doi:10.4293/jsls.2020.00073

Cited by 8 publications

(3 citation statements)

References 18 publications

(19 reference statements)

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“…Depending on the type of stapler, different insertion forks are utilized. For the Powered Echelon Flex® (Ethicon Endo-Surgery, Tokyo) stapler, the tissue is pulled toward the operator upon the cartridge fork closure [20]. Therefore, a cartridge fork was inserted into the esophagus in order to eliminate the gap between the insertion holes of the esophageal and the jejunum.…”

Section: Discussionmentioning

confidence: 99%

Ingenuity of overlap esophagojejunostomy using a linear stapler in laparoscopic total or proximal gastrectomy

Hirahara

Matsubara

Hayashi

et al. 2022

Preprint

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Background: Intracorporeal esophagojejunostomy in laparoscopy-assisted total or proximal gastrectomy is highly difficult. We developed ingenuity of overlap esophagojejunostomyusing a linear stapler to avoid stapler-related intraoperative complications. Methods: After lymph node dissection was completed, the esophagus was transected in the anterior-posterior direction. The jejunum was divided with a linear stapler approximately 20 cm distal to the ligament of Treitz. A small enterotomy was then created at 5 cm distal from the elevated jejunal stump to insert the linear stapler cartridge. A full-thickness incision was created with an electric knife using the tip of the nasogastric tube (NGT) pressed against the posterior wall side of the esophageal stump as a guide. Full-thickness sutures were applied on both the anterior and posterior walls of the entry hole in the esophageal stump to prevent mis-insertion of the anvil fork into the submucosal layer of esophagus. The thread on the posterior wall side was guided to the outside of the abdominal cavity through the port, into which the linear stapler was inserted to perform side-to-side anastomosis. A 45-mm cartridge fork and an anvil fork were inserted to the entry holes of the elevated jejunum and the esophageal stump, respectively. The esophageal stump was gently grasped. The thread on the posterior wall side was pulled from outside of the abdominal cavity through the port to eliminate the gap between the esophageal wall and the jejunal wall. The linear stapler was fired to create anastomosis after confirming that the anvil fork was not mis-inserted into the submucosal layer of esophagus and there was no gap between the esophagus and the elevated jejunum. The insertion hole was closed with hand-sewn sutures or linear staples to complete the esophagojejunostomy. Results:Seven patients received this procedure with no stapler-related complications. Conclusions: This method enables us to perform an easier and more stable esophagojejunostomy.

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Section: Discussionmentioning

confidence: 99%

Ingenuity of overlap esophagojejunostomy using a linear stapler in laparoscopic total or proximal gastrectomy

Hirahara

Matsubara

Hayashi

et al. 2022

Preprint

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“…With LSG, staple line problems remain a concern with reported leak rates ranging from 1.1 to 4.7% [ 11 ] and hemorrhage in up to 4% of the cases [ 12 ]. Both of these serious complications are technique dependent and are related to the degree of staple compression and the appropriateness of staple height selection.…”

Section: Introductionmentioning

confidence: 99%

Staple line reinforcement with nebulized cyanoacrylate glue in laparoscopic sleeve gastrectomy: A propensity score-matched study

et al. 2022

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Background A dreaded complication of laparoscopic sleeve gastrectomy (LSG) is suture leak. The study aimed to assess the efficacy of the nebulized comonomer Glubran 2® (N-butyl-cyanoacrylate + metacrylosysolfolane) applied to the LSG staple line. Methods A propensity-matched comparison analysis was conducted in 125 patients undergoing LSG between 2017 and 2019. Groups included those treated with Glubran® (group 1, n = 70) and those without Glubran® treatment (group 2, n = 55). Results There were differences in the mean body mass index (44.4 vs 43 kg/m2; P < 0.05) between the groups. There was a non-significant increase in the operative time for group 1 compared with group 2 (97 ± 8 vs 93.8 ± 10.7 min; P = 0.07), with a greater amount of estimated blood loss (94.5 mL vs 87.8; P < 0.01). There were more severe complications in group 2 over group 1 cases (8 vs 0%; P < 0.05), although postoperative bleeding did not differ between the two groups (1.4 vs 5.4%). There were no postoperative leaks in group 1 patients, but there were two leaks in group 2 cases with an increased length of hospital stay in patients with a leak. Conclusion Glubran® LSG support may reduce leak risk without increasing operating time.

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“…2 (Medtronic, Minneapolis, MN) were both found to be safe and reliable and resulted in similar surgical outcomes. In a randomized prospective study of laparoscopic SG, 8 the AEON Endostapler was found to have less bleeding at the staple line than the Echelon Flex Powered Stapler (Ethicon Inc., Somerville, NJ). A review of 50 patients undergoing laparoscopic bariatric surgery with the AEON Endostapler found only minor staple line bleeding at the time of surgery and 1 patient that required laparoscopic oversewing of a bleeding short gastric vessel unrelated to the staple line 9…”

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confidence: 99%

Evaluation of Alternate Laparoscopic Stapling Device for Bariatric Surgery

Walton,

Broussard

2023

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: As laparoscopic bariatric surgical techniques have matured, the incidence of complications has decreased over time. Surgical stapling devices are commonly used for resection and anastomosis of gastric tissue during bariatric surgery. The purpose of this study is to assess and compare complication rates and clinical outcomes between patient cohorts using 2 different approved stapling devices. Materials and Methods: Clinical outcomes were retrospectively compared for patients undergoing bariatric surgery between April 2019 and December 2020 using laparoscopic surgical stapling device A (LSSD-A) against outcomes between January 2017 and September 2018 using laparoscopic surgical stapling device B (LSSD-B). Tradenames for LSSD-A and LSSD-B were AEON Endostapler and Endo GIA with Tri-Staple Technology, respectively. Results: In all, 814 patients underwent laparoscopic bariatric operation using LSSD-A and 1034 using LSSD-B. Laparoscopic surgery included sleeve gastrectomy (n=1359, 73.5%), Roux-en-Y gastric bypass (RYGB) (n=425, 23.0%), and single anastomosis duodenoileostomy with gastric sleeve (n=64, 3.5%). Stapler-related complications were evenly distributed over the 20.9-month LSSD-B study period. No stapler-related complications were seen in the last 13 months of the LSSD-A study period, during which time 428 (52.5%) laparoscopic bariatric operations were performed. One staple line leak was observed, occurring in the LSSD-B group. Patients undergoing laparoscopic RYGB with LSSD-A had fewer overall complications, fewer transfusions, and fewer reoperations for staple line bleeding. Conclusions: Both LSSD-A and LSSD-B were safe and effective in the performance of laparoscopic bariatric operations with low complication rates and comparable clinical performance in sleeve gastrectomy and single anastomosis duodenoileostomy with gastric sleeve. Statistically significant differences in complication rates were observed in RYGB favoring LSSD-A.

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Improving Hemostasis in Sleeve Gastrectomy With Alternative Stapler

Cited by 8 publications

References 18 publications

Ingenuity of overlap esophagojejunostomy using a linear stapler in laparoscopic total or proximal gastrectomy

Ingenuity of overlap esophagojejunostomy using a linear stapler in laparoscopic total or proximal gastrectomy

Staple line reinforcement with nebulized cyanoacrylate glue in laparoscopic sleeve gastrectomy: A propensity score-matched study

Evaluation of Alternate Laparoscopic Stapling Device for Bariatric Surgery

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