Reinforcing Gastric Staple-Lines with Bovine Pericardial Strips May Decrease the Likelihood of Gastric Leak after Laparoscopic Roux-en-Y Gastric Bypass

Abstract

In this non-randomized trial, BPS were found to be easy and safe to use. In addition, staple-line hemorrhage was essentially non-existent. Although the reduction in gastric staple-line leak rate may also be attributed to learning curve, there were no acute leaks in 250 patients with BPS, which is below the published norms.

Gastrointestinal Hemorrhage after Laparoscopic Gastric Bypass

“…Peri-Strips Dry ® (Synovis, Saint Paul, MN) are composed of two strips of biological tissue derived from bovine pericardium that are applied to the linear stapler and act as a buttressing material at the staple-lines. 9,10 Seamguard ® (W. L. Gore & Associates, Flagstaff, AZ) staple-line reinforcement works in a similar fashion using ePTFE instead of biologic tissue. De la Torre and colleagues 11 reported the use of Seamguard ® on 50 laparoscopic RYGBP patients; they did not find any postoperative GI hemorrhages in their study.…”

Buttressing Staples with Cholecyst-derived Extracellular Matrix (CEM) Reinforces Staple Lines in an Ex Vivo Peristaltic Inflation Model

“…Examples of clinically available buttress reinforcement materials are bovine pericardium (Peri-strips ® ), [15][16][17][18][19] expanded-polytetrafluoroethylene (ePTFE ® ), 18,20 polyglycolic acid (PGA)-trimethylene carbonate (TMC) copolymer (Gore Seamgaurd ® ) 21,22 and small intestinal submucosa (Surgisis ® ) [23][24][25][26] . These products have demonstrated some success in reducing leakage and bleeding complications associated with staple lines.…”

Buttressing of the Staple Line in Gastrointestinal Anastomoses: Overview of New Technology Designed to Reduce Perioperative Complications

“…The two studies investigating this technique showed positive results regarding leakage and bleeding [34, 35] which were markedly reduced.…”

“…In addition to pulmonary resections, bovine pericardium staple line reinforcement has proven to be successful in bariatric procedures in several studies [34, 35]. During laparoscopic Roux-en-Y gastric bypasses, blood loss was significantly decreased or even absent, thereby improving the visibility with fewer conversions and reduced operating time.…”