The Science of Stapling and Leaks

Abstract

Staple-line leaks represent an unwanted, yet seemingly unavoidable, complication of stapling associated with bariatric surgery. Although, "folk legends" abound as to precluding leaks, little has been written based on basic research and understanding of stapling mechanics. This article reviews the history of stapling and discusses the implications of understanding the biomechanics of stapling living tissue. Finally, three leak studies evaluating ways to optimize staple-line strength are presented, and a large bariatric clinical series is reviewed.

Laparoscopic sleeve gastrectomy: perioperative outcomes, weight loss and impact on type 2 diabetes mellitus over 2 years

“…The risk for staple line bleeding can be reduced with the use of the optimal staple length relative to tissue thickness. 9 We use green loads (4.1 mm staple height) to divide the thicker antral tissue and switch to blue loads (3.5 mm staple height) for the corpus and fundus. We selectively clip or oversew staple line bleeds.…”

Buttressing the Stapler Line in Laparoscopic Sleeve Gastrectomy; Is It Really Necessary?

“…Dikiş hattının ayrışması mekanik (teknik) ve iskemik sebeplerden dolayı meydana gelir. Mekanik sebeplerden oluşan kaçaklar ilk 48 saat içinde oluşurken iskemi kaynaklı ayrışmalar inflamatuar ve fibrotik yanıtın en yoğun olduğu 5-7. günler arasında olur 9 . Dikiş hattından olan kanamayı ve ayrışmayı önlemek için birçok yöntem denenmiştir.…”

WhatsApp© Assistance in Bariatric Surgery

“…Other authors have stated that close monitoring after bariatric surgery are very important [3][4][5][6] in all type of bariatric surgery situations but none had addressed that a simple test using current simple monitoring with WhatsApp© assistance after discharge can be easily performed [7].…”