Total Stapled, Total Intra-Abdominal (TSTI) Laparoscopic Roux-en-Y Gastric Bypass: One Leak in 1,000 Cases

Carrasquilla, Carlos; English, Wayne J.; Esposito, Paul W.; Gianos, Jennifer

doi:10.1381/096089204323093372

Cited by 47 publications

(23 citation statements)

References 13 publications

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“…BAND-to-RYGBP revision patients is comparable to that reported in primary (initial) RYGBP series [3,17,23] and is lower than that reported in revision series from vertical-banded gastroplasty (VBG) or silastic ring vertical gastroplasty (SRVG) to RYGBP [4,7,8,11,19,20,24]. It is especially important to note that no leaks or other serious complications occurred in our series of revision patients.…”

Section: Discussionsupporting

confidence: 71%

Laparoscopic revision from LAP-BAND® to gastric bypass

et al. 2007

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Section: Discussionsupporting

confidence: 71%

Laparoscopic revision from LAP-BAND® to gastric bypass

et al. 2007

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“…Endoscopic surgical stapling devices (henceforth, staplers) were introduced to facilitate tissue approximation and transection during endoscopic surgery 12 . Staplers simplify the procedure and require less skill of the surgeon, but have been associated with complications, including leakage from staple lines, bleeding, and fistula formation [13][14][15] . The first powered stapler (i.e.…”

Section: Introductionmentioning

confidence: 99%

Comparison of economic and clinical outcomes between patients undergoing laparoscopic bariatric surgery with powered versus manual endoscopic surgical staplers

Roy¹,

Yoo

Yadalam

et al. 2017

Journal of Medical Economics

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Aims: To compare economic and clinical outcomes between patients undergoing laparoscopic Rouxen-Y gastric bypass (LRY) or laparoscopic sleeve gastrectomy (LSG) with use of powered vs manual endoscopic surgical staplers. Materials and methods: Patients (aged !21 years) who underwent LRY or LSG during a hospital admission (January 1, 2012-September 30, 2015 were identified from the Premier Perspective Hospital Database. Use of powered vs manual staplers was identified from hospital administrative billing records. Multivariable analyses were used to compare the following outcomes between the powered and manual stapler groups, adjusting for patient and hospital characteristics and hospital-level clustering: hospital length of stay (LOS), total hospital costs, medical/surgical supply costs, room and board costs, operating room costs, operating room time, discharge status, bleeding/transfusion during the hospital admission, and 30, 60, and 90-day all-cause readmissions. Results: The powered and manual stapler groups comprised 9,851 patients (mean age ¼ 44.6 years; 79.3% female) and 21,558 patients (mean age ¼ 45.0 years; 78.0% female), respectively. In the multivariable analyses, adjusted mean hospital LOS was 2.1 days for both the powered and manual stapler groups (p ¼ .981). Adjusted mean total hospital costs ($12,415 vs $13,547, p ¼ .003), adjusted mean supply costs ($4,629 vs $5,217, p ¼ .011), and adjusted mean operating room costs ($4,126 vs $4,413, p ¼ .009) were significantly lower in the powered vs manual stapler group. The adjusted rate of bleeding and/or transfusion during the hospital admission (2.46% vs 3.22%, p ¼ .025) was significantly lower in the powered vs manual stapler group. The adjusted rates of 30, 60, and 90-day all-cause readmissions were similar between the groups (all p > .05). Sub-analysis by manufacturer showed similar results. Limitations: This observational study cannot establish causal linkages. Conclusions: In this analysis of patients who underwent LRY or LSG, the use of powered staplers was associated with better economic outcomes, and a lower rate of bleeding/transfusion vs manual staplers in the real-world setting.ARTICLE HISTORY

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“…Although these devices are generally safe and effective, the correct closed staple limb length must be selected for the thickness of the tissues involved and the device must provide the correct tissue compression [5]. Staple-line failures in gastric bypass operations have been reported in 0.1-5.3% of cases [9][10][11] and may lead to peritonitis and/or abscess formation. If not managed successfully, staple-line failure could cause severe sepsis, multiple organ failure, and even death [10].…”

Section: Introductionmentioning

confidence: 99%

The effect of tissue compression on circular stapler line failure

2011

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Maximum intraluminal pressure of an anastomosis in this porcine model correlated most strongly with the compression of the tissue involved in the anastomosis. This experimental model provides a framework for constructing a systematic approach to creating an anastomosis with sufficient mechanical strength. However, this study was not intended to establish the upper range of tissue compression beyond which a permanent tissue injury may occur.

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Total Stapled, Total Intra-Abdominal (TSTI) Laparoscopic Roux-en-Y Gastric Bypass: One Leak in 1,000 Cases

Abstract: Although this was a non-randomized study, the results found a considerable improvement in the incidence of morbidity and mortality, and a remarkable decrease in the frequency of leaks.

Cited by 47 publications

References 13 publications

Laparoscopic revision from LAP-BAND® to gastric bypass

Laparoscopic revision from LAP-BAND® to gastric bypass

Comparison of economic and clinical outcomes between patients undergoing laparoscopic bariatric surgery with powered versus manual endoscopic surgical staplers

The effect of tissue compression on circular stapler line failure

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