Abstract
BackgroundLeaks 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.MethodsSG 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/mm2 on the fundus, midbody, and antrum.ResultsWe enrolled 26 SG patients (15 women, 11 men; mean age 36.8 years). Body mass index (BMI) averaged 45.3 kg/m2 overall, 44.7 kg/m2 for males and 45.7 kg/m2 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).ConclusionBecause 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.
Highlights
The current clinical practice of selecting a staple cartridge can be categorized into two methods: singular and variable
analysis of covariance (ANCOVA) demonstrated sex to be significantly correlated with the length of the stomach, which was significantly longer in males
The suitability of a particular cartridge for a location depends on the tissue thickness at that location
Summary
The current clinical practice of selecting a staple cartridge can be categorized into two methods: singular and variable. The surgeon uses only one type of staple cartridge (typically black) to create the entire sleeve. This method risks bleeding or leaking if the thickness of the stomach is outside the indicated range of the cartridge. The surgeon starts with the thickest load and chooses subsequent staple loads based on how the tissues feel. The downfall of this tactile-feedback method is its subjectivity. A thickness calibration device is needed to determine correct staple height
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