Stapler-less burst pressure in an ex vivo human gastric tissue: a randomized controlled trial

Gianmattia Del Genio,Mariachiara Lanza Volpe,Salvatore Tolone,Domenico Parmeggiani,Claudio Gambardella,Ludovico Docimo,Francesco Saverio Lucido,Luigi Brusciano

doi:10.1007/s13304-021-00975-y

Gianmattia Del Genio, Mariachiara Lanza Volpe + Show 6 more

Open Access

https://doi.org/10.1007/s13304-021-00975-y

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Abstract

Stapler-less laparoscopic sleeve gastrectomy (LSG) is emerging as a new potential affordable cost-effective alternative procedure. However, no pre-clinical data are currently available on human tissue. We aimed to evaluate whether traditionally suturing without the use of surgical stapling may produce a comparable bursting pressure on human gastric tissue. A prospective cohort of consecutive patients undergoing LSG was divided in two groups to compare a barbed extra-mucosal running suture (stapler-less) versus a standard stapler line. A burst pressure test was applied to the gastric specimen employing high-resolution manometric catheter. Type, location and features of the leak were described. We enrolled a total of 40 obese patients, 20 patients for each group. Median burst pressures of the stapler-less group resulted statistically significant increased (p < 0.0001) than the one in standard stapler group. In all cases, leak occurred along the surgical closure site independently from the used technique (group 1 vs 2; p = N.S.), more often at the proximal stomach (p < 0.05). In human ex vivo model, traditional surgical suture (i.e. running hand-sewn) produced an effective temporary closure, with superior resistance to increasing volume and pressure. How this may impact on clinical LSG outcomes needs further evaluations and was not the object of this study.

Highlights

Given the rising rate of morbid obesity and associated comorbidities with increasing financial pressures on healthcare systems worldwide, alternative ways to carry out costeffective laparoscopic sleeve gastrectomy (LSG) are advocated [1, 2]
A prospective, open-labelled, randomized controlled trial was conducted to evaluate the feasibility of stapler-less sleeve gastrectomy in an ex vivo model
Between January 2020 and June 2020, a total of 54 morbid obesity patients referred to our institution to perform LSG. 5 patients did not meet inclusion criteria and 5 patients withdrew their consent to participate, whereas 44 met eligibility criteria and were randomly allocated in a 1:1 ratio to receive hand-sewn running suture or stapler closure

Summary

Introduction

Given the rising rate of morbid obesity and associated comorbidities with increasing financial pressures on healthcare systems worldwide, alternative ways to carry out costeffective laparoscopic sleeve gastrectomy (LSG) are advocated [1, 2].Recently, staple line reinforcement by oversewing or buttressing with various materials seems to reduce the incidence of leak and bleeding [3,4,5].That is, some authors reported limited initial reports of stapler-less sleeve gastrectomy created via energy-based.

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