Linear stapling of the short gastric vessels reduces blood loss and splenectomy at oesophageal and gastric surgery

Abstract

Increased operative blood loss, blood transfusion and nontherapeutic splenectomy negatively influence postoperative morbidity and mortality following esophageal or gastric resection. A critical point at which blood loss and iatrogenic splenic injury occurs is at the time of division of the short gastric vessels. We examined the efficacy of using a laparoscopic linear cutting stapler (developed for minimal access surgery) to divide with the short gastric vessels at open surgery. Fifty-six patients were included. In 28 consecutive patients the linear stapler was used when dividing the short gastric vessels. These were compared to 28 matched controls (short gastric vessels were divided between hemostats and ligated). In the two patient groups, patient age, body mass index, and preoperative hemoglobin levels were similar. Operation time, splenectomy rates, blood transfusion, and mean transfusion volume were all significantly reduced in the group where the stapler was used. Use of a linear cutting stapler reduced operation time, blood product use, and incidental splenectomy in patients undergoing radical open esophageal and gastric surgery.