Limits...
A Thickness Calibration Device Is Needed to Determine Staple Height and Avoid Leaks in Laparoscopic Sleeve Gastrectomy.

Huang R, Gagner M - Obes Surg (2015)

Bottom Line: Although male patients had a thicker stomach antrum than female patients (3.12 vs. 3.09 mm), the midbody (2.57 vs. 3.09 mm) and proximal areas (1.67 vs. 1.72 mm) were thicker in female patients.However, some maximum fundus thicknesses were up to 2.83 mm in females and 2.28 mm in males.Some antra were as thick as 4.07 mm in females and 5.39 mm in males.

View Article: PubMed Central - PubMed

Affiliation: Boehringer Laboratories, LLC, Phoenixville, PA, USA. rhuang@boehringerlabs.com.

ABSTRACT

Background: Leaks after sleeve gastrectomy (SG) may be due to a mismatch between staple height and tissue thickness. The aim of this study was to determine the range of gastric thicknesses in three areas of stapling.

Methods: SG was performed using a 40-Fr suction calibration system 4 cm from the pylorus. Measurement of combined gastric walls was accomplished with an applied pressure of 8 g/mm(2) on the fundus, midbody, and antrum.

Results: We enrolled 26 SG patients (15 women, 11 men; mean age 36.8 years). Body mass index (BMI) averaged 45.3 kg/m(2) overall, 44.7 kg/m(2) for males and 45.7 kg/m(2) for females. Although male patients had a thicker stomach antrum than female patients (3.12 vs. 3.09 mm), the midbody (2.57 vs. 3.09 mm) and proximal areas (1.67 vs. 1.72 mm) were thicker in female patients. However, some maximum fundus thicknesses were up to 2.83 mm in females and 2.28 mm in males. Some antra were as thick as 4.07 mm in females and 5.39 mm in males. Also, men had a longer average staple line (22.95 vs. 19.90 cm).

Conclusion: Because of the range of gastric thicknesses, a single staple height cannot be used to appose the full range of gastric wall thicknesses without potentially causing necrosis or poor apposition. To help avoid leaks, a thickness calibration device is needed to determine correct staple height.

Show MeSH
Normal distribution of the use of the Covidien black cartridge at the antra of females
© Copyright Policy - OpenAccess
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4644197&req=5

Fig4: Normal distribution of the use of the Covidien black cartridge at the antra of females

Mentions: The probability P(xmin < x < xmax, black), i.e., the suitability of using the Covidien Tri-Staple™ black cartridge at the antrum for every female patient in this study (Fig. 4), is 16.55 %. Because the mean thickness of the antrum in females was much higher than that of the published closed staple height (3.09 vs. 2.25 mm), the use of the Covidien Tri-Staple ™ black cartridge at the antrum was appropriate in only one out of six female patients.Fig. 4


A Thickness Calibration Device Is Needed to Determine Staple Height and Avoid Leaks in Laparoscopic Sleeve Gastrectomy.

Huang R, Gagner M - Obes Surg (2015)

Normal distribution of the use of the Covidien black cartridge at the antra of females
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4644197&req=5

Fig4: Normal distribution of the use of the Covidien black cartridge at the antra of females
Mentions: The probability P(xmin < x < xmax, black), i.e., the suitability of using the Covidien Tri-Staple™ black cartridge at the antrum for every female patient in this study (Fig. 4), is 16.55 %. Because the mean thickness of the antrum in females was much higher than that of the published closed staple height (3.09 vs. 2.25 mm), the use of the Covidien Tri-Staple ™ black cartridge at the antrum was appropriate in only one out of six female patients.Fig. 4

Bottom Line: Although male patients had a thicker stomach antrum than female patients (3.12 vs. 3.09 mm), the midbody (2.57 vs. 3.09 mm) and proximal areas (1.67 vs. 1.72 mm) were thicker in female patients.However, some maximum fundus thicknesses were up to 2.83 mm in females and 2.28 mm in males.Some antra were as thick as 4.07 mm in females and 5.39 mm in males.

View Article: PubMed Central - PubMed

Affiliation: Boehringer Laboratories, LLC, Phoenixville, PA, USA. rhuang@boehringerlabs.com.

ABSTRACT

Background: Leaks after sleeve gastrectomy (SG) may be due to a mismatch between staple height and tissue thickness. The aim of this study was to determine the range of gastric thicknesses in three areas of stapling.

Methods: SG was performed using a 40-Fr suction calibration system 4 cm from the pylorus. Measurement of combined gastric walls was accomplished with an applied pressure of 8 g/mm(2) on the fundus, midbody, and antrum.

Results: We enrolled 26 SG patients (15 women, 11 men; mean age 36.8 years). Body mass index (BMI) averaged 45.3 kg/m(2) overall, 44.7 kg/m(2) for males and 45.7 kg/m(2) for females. Although male patients had a thicker stomach antrum than female patients (3.12 vs. 3.09 mm), the midbody (2.57 vs. 3.09 mm) and proximal areas (1.67 vs. 1.72 mm) were thicker in female patients. However, some maximum fundus thicknesses were up to 2.83 mm in females and 2.28 mm in males. Some antra were as thick as 4.07 mm in females and 5.39 mm in males. Also, men had a longer average staple line (22.95 vs. 19.90 cm).

Conclusion: Because of the range of gastric thicknesses, a single staple height cannot be used to appose the full range of gastric wall thicknesses without potentially causing necrosis or poor apposition. To help avoid leaks, a thickness calibration device is needed to determine correct staple height.

Show MeSH