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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.

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Suitability of particular color cartridges with the Covidien stapler at female a antrum, b midbody, and c fundus and male d antrum, e midbody, and f fundus
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Fig5: Suitability of particular color cartridges with the Covidien stapler at female a antrum, b midbody, and c fundus and male d antrum, e midbody, and f fundus

Mentions: The same analysis was applied to all other Covidien Tri-Staple ™ color cartridges at the midbody and fundus (Fig. 5a–c). For example, a purple, tan, or gray cartridge at the antrum in female patients was not particularly suitable (3.90, 0.52, and 0.04 %, respectively). Using the same method, the most appropriate color cartridge at the female midbody was also black (39.51 %). Interestingly, the appropriate choice of cartridge at the fundus could be either black or purple (55.23 and 57.13 %, respectively). However, patient demographics from the Elariny study demonstrated the purple cartridge to be more suitable than the black cartridge (90.45 vs. 65.26 %) at the fundus in female patients [4]. Similarly, in the male patients in the present study, the highest probabilities for appropriate cartridge color at the antrum, midbody, and fundus were black (19.9 %), black (42.84 %), and purple (86.02 %), respectively (Fig. 5d–f), whereas for the male patients in the Elariny study, the black cartridge was more suitable than the purple (81.41 vs. 71.50 %) at the fundus. This variation in cartridge suitability at the fundus underscores the need for surgeons to be certain of the tissue thickness before choosing a cartridge.Fig. 5


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

Huang R, Gagner M - Obes Surg (2015)

Suitability of particular color cartridges with the Covidien stapler at female a antrum, b midbody, and c fundus and male d antrum, e midbody, and f fundus
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig5: Suitability of particular color cartridges with the Covidien stapler at female a antrum, b midbody, and c fundus and male d antrum, e midbody, and f fundus
Mentions: The same analysis was applied to all other Covidien Tri-Staple ™ color cartridges at the midbody and fundus (Fig. 5a–c). For example, a purple, tan, or gray cartridge at the antrum in female patients was not particularly suitable (3.90, 0.52, and 0.04 %, respectively). Using the same method, the most appropriate color cartridge at the female midbody was also black (39.51 %). Interestingly, the appropriate choice of cartridge at the fundus could be either black or purple (55.23 and 57.13 %, respectively). However, patient demographics from the Elariny study demonstrated the purple cartridge to be more suitable than the black cartridge (90.45 vs. 65.26 %) at the fundus in female patients [4]. Similarly, in the male patients in the present study, the highest probabilities for appropriate cartridge color at the antrum, midbody, and fundus were black (19.9 %), black (42.84 %), and purple (86.02 %), respectively (Fig. 5d–f), whereas for the male patients in the Elariny study, the black cartridge was more suitable than the purple (81.41 vs. 71.50 %) at the fundus. This variation in cartridge suitability at the fundus underscores the need for surgeons to be certain of the tissue thickness before choosing a cartridge.Fig. 5

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