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Staple line reinforcement

Mohamed Hany, Mohammed Ibrahim
INTRODUCTION: Laparoscopic sleeve gastrectomy (LSG) is now a popular bariatric procedure worldwide with rising prevalence over the last decade. Staple line leak and bleeding are the most dangerous complications of LSG. Staple line reinforcement (SLR) by oversewing the staple line was suggested to reduce the incidence of leak and bleeding. We designed a randomized controlled prospective study to investigate the value of SLR by invaginating the whole staple line using unidirectional absorbable 3/0 V-Loc 180 sutures (Covidien, Mansfield, MA, USA) to no SLR in LSG...
March 5, 2018: Obesity Surgery
Vikrom K Dhar, Dennis J Hanseman, Brad M Watkins, Ian M Paquette, Shimul A Shah, Jonathan R Thompson
BACKGROUND: The impact of operative technique on outcomes in laparoscopic sleeve gastrectomy has been explored previously; however, the relative importance of patient characteristics remains unknown. Our aim was to characterize national variability in operative technique for laparoscopic sleeve gastrectomy and determine whether patient-specific factors are more critical to predicting outcomes. METHODS: We queried the database of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program for laparoscopic sleeve gastrostomies performed in 2015 (n = 88,845)...
March 2018: Surgery
Imad El Moussaoui, Augustin Limbga, Abdelilah Mehdi
BACKGROUND: Bleeding and staple-line leak, are the most common complications of laparoscopic sleeve gastrectomy. To decrease the incidence of this complications, a variety of intra-operative reinforcement of staple line are used. Reinforced GIA is a new automatic suture device with pre-attached synthetic tissue reinforcement, but no study has evaluated its use in sleeve gastrectomy. The objective of this study is to evaluate the efficacy and safety of this new staple line reinforcement technique in laparoscopic sleeve gastrectomy...
February 1, 2018: Minerva Chirurgica
Min Chan Kim, Sang Yun Kim, Kwan Woo Kim
Purpose: Laparoscopic gastrectomy is accepted as a standard treatment for patients with early gastric cancer in Korea, Japan, and China. However, duodenal stump leakage remains a fatal complication after gastrectomy. We conducted a prospective phase II study to evaluate the safety of the new technique of laparoscopic reinforcement suture (LARS) on the duodenal stump. Materials and Methods: The estimated number of patients required for this study was 100 for a period of 18 months...
December 2017: Journal of Gastric Cancer
Sang Yun Kim, So Hyun Nam, Jae Seok Min, Min Chan Kim
Purpose: Duodenal stump fistula (DSF) is a serious complication after gastrectomy for gastric cancer. Although risk evaluation and management of DSF were presented by some investigators, there was no technical attempt has been made to prevent DSF during laparoscopic gastrectomy until now. Methods: Consecutive 99 patients were enrolled from April 2014 to February 2016 in 2 institutes. All patients were performed laparoscopic gastrectomy for gastric cancer. After cutting of duodenal stump, laparoscopic reinforcement suture (LARS) commenced with continuous invagination method or interrupted method by barbed suture...
December 2017: Annals of Surgical Treatment and Research
Masahiro Kimura, Yoshiyuki Kuwabara, Satoshi Taniwaki, Akira Mitsui, Yasuyuki Shibata, Shuhei Ueno
BACKGROUND: Few studies have investigated the burst pressure of side-to-side anastomoses comparing different stapling devices that are commercially available. OBJECTIVES: We conducted side-to-side anastomoses with a variety of staplers and compared burst pressure in the crotch of the anastomoses. SETTING: Nagoya City East Medical Center. METHODS: We conducted side-to-side anastomoses with 9 staplers with different shapes and forms...
October 2, 2017: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
Manabu Kawai, Seiko Hirono, Ken-Ichi Okada, Sohei Satoi, Hiroaki Yanagimoto, Masanori Kon, Yoshiaki Murakami, Naru Kondo, Masayuki Sho, Takahiro Akahori, Hirochika Toyama, Takumi Fukumoto, Tsutomu Fujii, Ippei Matsumoto, Hidetoshi Eguchi, Hisashi Ikoma, Yutaka Takeda, Jiro Fujimoto, Hiroki Yamaue
PURPOSE: The safety and efficacy of reinforced staplers during distal pancreatectomy (DP) remain controversial because of the small sample size. This multicenter single-arm prospective study aims to evaluate the safety and efficacy of reinforced staplers with bioabsorbable material during DP. METHODS: Between October 2014 and August 2015, 121 patients scheduled for DP were enrolled in this study at 11 institutions in Japan. The primary endpoint was the incidence of clinically relevant pancreatic fistula...
December 2017: Langenbeck's Archives of Surgery
G C Kirby, C A W Macano, S M Nyasavajjala, M Sahloul, R Nijjar, M Daskalakis, M Richardson, R Singhal
INTRODUCTION: Leak following bariatric surgery continues to be associated with morbidity and rarely mortality. With improvement in surgical techniques and stapler design, leak rates have reduced drastically. Intra-operative high pressure Methylene blue leak test (HPMB) is one of the techniques employed to confirm integrity of anastomoses and staple lines. Despite this, evidence for its use remains limited. We evaluated the role of HPMB in detecting and preventing leaks. METHODS: A retrospective cohort of consecutive patients who underwent primary or revisional Laparoscopic Sleeve Gastrectomy (SG) or Laparoscopic Roux-en-Y Gastric bypass (RYGB) under the care of five surgeons in three centres across Birmingham, UK, between 2012 and 2016 were assessed...
November 2017: Annals of Medicine and Surgery
I Simal, M A García-Casillas, J Cerdà, L Pérez, B Fernández, M De la Torre, M Fanjul, E Molina, J C De Agustín
INTRODUCTION: Persistent air leak (PAL) is a common problem. We asses our experience in the management of these patients. MATERIAL AND METHODS: Retrospective review of patients with chest tubes after bronchopulmonary pneumothorax (due to lung resections, spontaneous pneumothorax, necrotizing pneumonia) from 2010 to 2015. We studied clinical data, PAL incidence, risk factors and treatment, considering PAL ≥ 5 days. RESULTS: Thirty-seven cases (28 patients) between 0-16years: 26 lung resections, 11 pneumothorax...
July 20, 2017: Cirugía Pediátrica: Organo Oficial de la Sociedad Española de Cirugía Pediátrica
Giorgio Lisi, Roberto Rossini, Irene Gentile, Giacomo Ruffo
INTRODUCTION: The main drawback of laparoscopic sleeve gastrectomy (LSG) is the severity of postoperative complications. Staple line reinforcement (SLR) is strongly advocated. Recently, over-sewing has been proposed as a cost-effective and helpful method for reinforcing the staple line. The purpose of this study was to report our initial experience with LSG comparing over-sewing over the entire staple line with the upper-third staple line. MATERIALS AND METHODS: All obese patients seen at Negrar Sacro Cuore, Don Calabria Hospital were entered into our prospective database and were retrospectively evaluated...
October 12, 2017: Surgical Technology International
Brett L Ecker, Matthew T McMillan, Valentina Allegrini, Claudio Bassi, Joal D Beane, Ross M Beckman, Stephen W Behrman, Euan J Dickson, Mark P Callery, John D Christein, Jeffrey A Drebin, Robert H Hollis, Michael G House, Nigel B Jamieson, Ammar A Javed, Tara S Kent, Michael D Kluger, Stacy J Kowalsky, Laura Maggino, Giuseppe Malleo, Vicente Valero, Lavanniya K P Velu, Amarra A Watkins, Christopher L Wolfgang, Amer H Zureikat, Charles M Vollmer
OBJECTIVE: To identify a clinical fistula risk score following distal pancreatectomy. BACKGROUND: Clinically relevant pancreatic fistula (CR-POPF) following distal pancreatectomy (DP) is a dominant contributor to procedural morbidity, yet risk factors attributable to CR-POPF and effective practices to reduce its occurrence remain elusive. METHODS: This multinational, retrospective study of 2026 DPs involved 52 surgeons at 10 institutions (2001-2016)...
August 29, 2017: Annals of Surgery
Giovanni Cesana, Stefano Cioffi, Riccardo Giorgi, Roberta Villa, Matteo Uccelli, Francesca Ciccarese, Giorgio Castello, Bruno Scotto, Stefano Olmi
BACKGROUND: The purpose of this paper was to search for predictive factors for proximal leakage after laparoscopic sleeve gastrectomy (LSG) in a large cohort from a single referral center. MATERIALS AND METHODS: One thousand seven hundred and thirty-eight patients, collected in a prospectively held database from 2008 to 2016, were retrospectively analyzed. The correlation between postoperative leakage and both preoperative (age, gender, height, weight, BMI, and obesity-related morbidities) and operative variables (the distance from pylorus at which the gastric section was started, operative time, experience of surgeons who performed the LSG, and the surgical materials used) was analyzed...
August 24, 2017: Obesity Surgery
Osama Taha, Mahmoud Abdelaal, Mohamed Talaat, Mohamed Abozeid
BACKGROUND: Varieties of intraoperative methods such as oversewing of staple lines or other reinforcement products are used for preventing the laparoscopic vertical sleeve gastrectomy (LSG) complications. The aim of this study is to evaluate the complication rates of the gastric stapling alone versus stapling with oversewing invagination of the staple line in the LSG. METHODS: This is a single-center randomized study, Patients were randomized to two groups, 200 patients underwent LSG without reinforcement of the staple line and 200 patients underwent LSG with oversewing of the staple line...
July 24, 2017: Obesity Surgery
Ohad Guetta, Amnon Ovnat, David Czeiger, Alex Vakhrushev, Gal Tsaban, Gilbert Sebbag
BACKGROUND: To evaluate early complications after LSG in regard of staple line reinforcement (SLR), bougie size, previous bariatric surgery and surgeon experience. METHODS: A retrospective cohort study of LSG patients at the Soroka University Medical Center (SUMC). Data was collected from digitalized database. RESULTS: Nine hundred eighty-four LSG cases were performed by three surgeons. Seventy-eight complications were observed (7.9%): 44 mild (4...
November 2017: Obesity Surgery
G Martines, R Digennaro, M De Fazio, P Capuano
Laparoscopic Sleeve Gastrectomy (LSG) is associated with serious complications, such as staple line leaks and bleeding. This paper presents a novel approach aimed at the successful consolidation of the suture by the use of the cyanoacrylate, here compared to the use of fibrin glue. Fifty consecutive patients, recruited from October 2015 to March 2016, were submitted to laparoscopic sleeve gastrectomy by standardized surgical technique. The staple line was reinforced with cyanoacrylate or fibrin glue. There were no post-operative complications and no operative time prolongation...
January 2017: Il Giornale di Chirurgia
Alper Yavuz, Hakan Buluş
Sleeve gastrectomy operations have become popular among restrictive obesity surgeons, due to its effectiveness for losing weight and acceptable complication rates. However, leakage is a significant problem in these operations. In this ex vivo study, we tried to understand mechanisms of leakage and to examine the effects of two different types of frequently referred reinforcement techniques using sutures. The resected gastric specimens that were removed during sleeve gastrectomy operations were used in this ex vivo study...
June 2017: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Marius Nedelcu, Thierry Manos, Michel Gagner, Imane Eddbali, Ahmed Ahmed, Patrick Noel
BACKGROUND: Leaks after laparoscopic sleeve gastrectomy (LSG) are serious complications of this procedure. The objective of the present study was to evaluate the costs of leaks after LSG. SETTING: Private hospital, France. METHODS: A retrospective analysis was conducted on a prospective cohort of 2012 cases of LSG between September 2005 and December 2014. Data were collected on all diagnostic and therapeutic measures necessary to manage leaks, ward, and intensive care unit (ICU) length of stay...
November 2017: Surgical Endoscopy
Gregoire Mercier, Marcelo Loureiro, Vera Georgescu, El Mehdi Skalli, Marius Nedelcu, Mohamed Ramadan, Jean Michel Fabre, Patrick Lefebvre, David Nocca
RATIONALE, AIMS, AND OBJECTIVES: Laparoscopic sleeve gastrectomy (LSG) is one of the most common bariatric procedures. Gastric leaks and bleeding are the most frequent complications, associated with a high clinical and economic burden. The best method of staple line reinforcement in LSG is debated. Surgical glue is one of the options available. The aim of this study was to assess the safety, efficiency, and relative cost-effectiveness of surgical glue used to perform LSG in morbid obese adults as compared with standard stapling...
March 21, 2017: Journal of Evaluation in Clinical Practice
Marcelo Loureiro, Abdulah Sultan, Mohannad Alhaddad, Hatem Mostafa, David Nocca, Marius Nedelcu, Walled Buhaimed
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is the most common bariatric surgery performed worldwide. Improvements in LSG have been suggested to achieve better weight loss or to lessen the complications rates. We propose a change in the standard technique to privilege the use of thinner instruments, the needlescopic sleeve gastrectomy (NSG). METHODS: A 40-year-old female, BMI 40, with no previous abdominal surgery was selected for a NSG. She was placed in a semi-sitting position with the surgeon standing between the legs...
October 2017: Surgical Endoscopy
S J Chapman, B Shelton, M Maruthappu, P Singh, P McCulloch, A Bhangu
BACKGROUND: Evidence supporting the implementation of novel surgical devices is unstandardized, despite recommendations for assessing novel innovations. This study aimed to determine the proportion of novel implantable devices used in gastrointestinal surgery that are supported by evidence from RCTs. METHODS: A list of novel implantable devices placed intra-abdominally during gastrointestinal surgery was produced. Systematic searches were performed for all devices via PubMed and clinical trial registries...
May 2017: British Journal of Surgery
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