Pressure tolerance of newly constructed staple lines in sleeve gastrectomy and duodenal switch

Intraoperative leak testing has no correlation with leak after laparoscopic sleeve gastrectomy

“…Nasogastric tube has been associated with lung perforation, esophageal perforation, massive bleeding, and other mediastinal complications [11,27,28]; intraoperative orogastric tube placement could lead to a similar sequela. It has also been theorized that the shear forces on staple lines engendered by the leak testing process could result in perioperative staple line weakness, although scientific data seem to disprove this theory [29].…”

Staple Line Reinforcement Methods in Laparoscopic Sleeve Gastrectomy: Comparison of Burst Pressures and Leaks

“…During evaluation, the most frequent leak site was the proximal stomach, which has been shown to offer the weakest resistance to pressure increases. 21 , 22 On the other hand, the fundus had the largest diameter in the resected stomach, which allowed it to distend under higher intraluminal pressure, according to the Laplace law. All of the leaks of the resected stomachs occurred in the staple lines, similar to the results reported by Causey et al 22 A clinical leak just below the GEJ was detected in 1 patient in the suture group.…”

“…Although gastric wall thickness has been reported to vary, it is thick in the antrum (3.1 mm), moderate in the body (2.4 mm), and thin in the fundus (1.7 mm). 22 , 23 The choice of staple height is very important when a buttressing material is added. The height of the buttress decreases the actual height of the staple, and a longer staple height should be considered for safe and proper closure.…”

Does gastric resection volume influence sleeve gastrectomy results? a prospective study

“…Causey MW et al 16 reported similar results about the leak pressure generated by the saline solution injection, suggesting the accuracy of this method of measurement. However, they showed no significant prevalence in the location of the leak.…”