Detailed anatomy of staple line crossings in sleeve gastrectomies for morbid obesity

Abstract

Sleeve gastrectomy is becoming an increasingly popular bariatric procedure. One of the main concerns is staple line leaks, which are troublesome to detect and manage in obese patients. It was suggested by several authors that leaks and fistulas are mainly localized in the proximal staple line and may result from distal stomach strictures. It was hypothesized that the weakest parts of the stapled stomach are the staple line crossings. However, detailed anatomy of these entities was never before described. Staple line on the removed part of the stomach is a mirror image of the staple line on the stomach sleeve. We present a 2-projection visualization of the staple line crossings (indicated with rings) in sleeve gastrectomy specimens. Radiographs of the specimens in 2 projections were obtained to visualize the staple line. Staple line crossings present a significant mechanistic defect with significant aberration of the staple line trajectory. These defects, although visually worrying, did not result in leaks when undergoing low-pressure distention of the specimen with methylene-dyed saline (Fig. 1, Fig. 2). Fig. 2Specimen 2: Panels A and B – X-rays in 2 different projections staple line crossings (indicated with rings). View Large Image Figure Viewer Download Hi-res image