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

Rose Huang, Michel Gagner, Rose Huang, Michel Gagner

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.

Keywords: Bleeding; Reloads; Sleeve gastrectomy; Stapler; Thickness.

Figures

Fig. 1
Fig. 1
Description of the three predetermined measurement locations. Fundus, 1 cm caudal to the edge of the fundus, 0.5 cm from the staple line; midbody, halfway between the fundus and the pylorus along the staple line, 0.5 cm from the staple line; antrum, 2 cm caudal to the pylorus along the staple line, 0.5 cm from the staple line. A antrum, F fundus, M midbody
Fig. 2
Fig. 2
Thickness measuring device
Fig. 3
Fig. 3
Plots of thickness vs. location for a female and b male patients in the present study and the Elariny study
Fig. 4
Fig. 4
Normal distribution of the use of the Covidien black cartridge at the antra of females
Fig. 5
Fig. 5
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
Fig. 6
Fig. 6
Suitability of particular color cartridges with the Ethicon stapler at female a antrum, b midbody, and c fundus and male d antrum, e midbody, and f fundus

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Source: PubMed

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