Caroline E Sheppard, Kevin A Whitlock,Daniel W Birch1 and Shahzeer Karmali
Background: Obesity is a chronic disease that affects over 500 million adults globally. Bariatric surgery is the only evidence-based treatment to achieve sustainable weight loss. Laparoscopic Sleeve Gastrectomy (LSG) is a restrictive procedure with important physiologic changes. Staple line dehiscence and hemorrhage represent two of the major complications associated with this procedure. Respectively, surgeons have attempted numerous modalities to avert these issues by using various stapling products, buttresses and hemostatic adjuncts. The purpose of this study is to analyze the utility of a Tri-staple non-buttressed stapler on the incidence of postoperative leakage and hemorrhage post LSG.
Methods: A retrospective review of medical records was performed for 97 consecutive patients that underwent LSG with the Tri-Staple™ between July 2011 and October 2012.
Results: The mean age of patients was 44.4 ± 9.2 years, with mean preoperative BMI of 48.5±10.6kg/m2. Preoperative comorbidities included Type 2 diabetes (34%), hypertension (42%), dyslipidemia (28%), and obstructive sleep apnea (43%). The mean operative time was 80.0 ± 22.0min. There were no intraoperative leaks identified. There were no documented postoperative leaks or bleeds after a median follow up of 12 months. At 12 months following surgery, BMI had significantly decreased to 33.9 ± 6.6 kg/m2 (p<0.05), corresponding to a EWL% of 54.8% ± 24.2%. HbA1c was significantly reduced after 1 year (6.7 ± 1.2 vs 5.6 ± 0.7, P<0.05).
Conclusion: The Tri-Staple™ configuration used in LSG seems to mitigate staple line failures. Furthermore, weight loss and co morbidity reduction was determined to be acceptable and equivalent to LSG using other staplers