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Braghetto I, Czwiklitzer G, Korn O, Brante P, Burgos A. RESULTS OF MECHANIC VERSUS MOTORIZED STAPLER USED IN GASTRIC SURGERY: PROSPECTIVE STUDY. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2024; 37:e1818. [PMID: 39230118 PMCID: PMC11363907 DOI: 10.1590/0102-6720202400025e1818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/02/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND Mechanic sutures represent an enormous benefit for digestive surgery in decreasing postoperative complications. Currently, the advantages of motorized stapler are under evaluation. AIMS To compare the efficacy of mechanic versus motorized stapler in gastric surgery, analyzing rate of leaks, bleeding, time of stapling, and postoperative complications. METHODS Ninety-eight patients were submitted to gastric surgery, divided into three groups: laparoscopic sleeve gastrectomy (LSG) (n=47), Roux-en-Y gastric bypass (LRYGB) (n=30), and laparoscopic distal gastrectomy (LDG) (n=21). Motorized staplers were employed in 61 patients. The number of firings, number of clips, time of total firings, total time to complete the surgery, and postoperative outcome were recorded in a specific protocol. RESULTS Patients submitted to LSG, LRYGB, and LDG recorded a shorter time to complete the procedure and a smaller number of firings were observed using motorized stapler (p<0.0001). No differences were identified regarding the number of clips used in patients submitted to LSG. In the group that used mechanic stapler to complete gastrojejunostomy, jejuno-jejuno-anastomosis, and jejunal transection, it was observed more prolonged time of firing and total time for finishing the procedure (p=0.0001). No intraoperative complications were found comparing the two devices used. Very similar findings were noted in the group of patients undergoing LDG. CONCLUSIONS The motorized stapler offers safety and efficacy as demonstrated in prior reports and is relevant since less total time of surgical procedure without intraoperative or postoperative complications were confirmed.
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Affiliation(s)
- Italo Braghetto
- Digestive and Bariatric Surgical Unit, Redsalud Providencia, Santiago, Chile
| | - Gustavo Czwiklitzer
- Digestive and Bariatric Surgical Unit, Redsalud Providencia, Santiago, Chile
| | - Owen Korn
- Digestive and Bariatric Surgical Unit, Redsalud Providencia, Santiago, Chile
| | - Percy Brante
- Digestive and Bariatric Surgical Unit, Redsalud Providencia, Santiago, Chile
| | - Ana Burgos
- Digestive and Bariatric Surgical Unit, Redsalud Providencia, Santiago, Chile
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Walton GF, Broussard TD. Evaluation of Alternate Laparoscopic Stapling Device for Bariatric Surgery. Surg Laparosc Endosc Percutan Tech 2023; 33:505-510. [PMID: 37523506 DOI: 10.1097/sle.0000000000001204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/20/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND As laparoscopic bariatric surgical techniques have matured, the incidence of complications has decreased over time. Surgical stapling devices are commonly used for resection and anastomosis of gastric tissue during bariatric surgery. The purpose of this study is to assess and compare complication rates and clinical outcomes between patient cohorts using 2 different approved stapling devices. MATERIALS AND METHODS Clinical outcomes were retrospectively compared for patients undergoing bariatric surgery between April 2019 and December 2020 using laparoscopic surgical stapling device A (LSSD-A) against outcomes between January 2017 and September 2018 using laparoscopic surgical stapling device B (LSSD-B). Tradenames for LSSD-A and LSSD-B were AEON Endostapler and Endo GIA with Tri-Staple Technology, respectively. RESULTS In all, 814 patients underwent laparoscopic bariatric operation using LSSD-A and 1034 using LSSD-B. Laparoscopic surgery included sleeve gastrectomy (n=1359, 73.5%), Roux-en-Y gastric bypass (RYGB) (n=425, 23.0%), and single anastomosis duodenoileostomy with gastric sleeve (n=64, 3.5%). Stapler-related complications were evenly distributed over the 20.9-month LSSD-B study period. No stapler-related complications were seen in the last 13 months of the LSSD-A study period, during which time 428 (52.5%) laparoscopic bariatric operations were performed. One staple line leak was observed, occurring in the LSSD-B group. Patients undergoing laparoscopic RYGB with LSSD-A had fewer overall complications, fewer transfusions, and fewer reoperations for staple line bleeding. CONCLUSIONS Both LSSD-A and LSSD-B were safe and effective in the performance of laparoscopic bariatric operations with low complication rates and comparable clinical performance in sleeve gastrectomy and single anastomosis duodenoileostomy with gastric sleeve. Statistically significant differences in complication rates were observed in RYGB favoring LSSD-A.
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Lauro E, Corridori I, Luciani L, Di Leo A, Sartori A, Andreuccetti J, Trojan D, Scudo G, Motta A, Pugno NM. Stapled fascial suture: ex vivo modeling and clinical implications. Surg Endosc 2022; 36:8797-8806. [PMID: 35578046 DOI: 10.1007/s00464-022-09304-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/23/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Recently, in the field of abdominal wall repair surgery, some minimally invasive procedures introduced the use of staplers to provide a retromuscular prosthetic repair. However, to the knowledge of the authors, there are little data in the literature about the outcomes of stapled sutures adoption for midline reconstruction. This study aims to investigate the biomechanics of stapled sutures, simple (stapled), or oversewn (hybrid), in comparison with handsewn suture. From the results obtained, we tried to draw indications for their use in a clinical context. METHODS Human cadaver fascia lata specimens, sutured (handsewn, stapled, or hybrid) or not, underwent tensile tests. The data on strength (maximal stress), ultimate strain (deformability), Young's modulus (rigidity), and dissipated specific energy (ability to absorb mechanical energy up to the breaking point) were recorded for each type of specimens and analyzed. RESULTS Stapled and hybrid suture showed a significantly higher strength (handsewn 0.83 MPa, stapled 2.10 MPa, hybrid 2.68 MPa) and a trend toward a lower ultimate strain as compared to manual sutures (handsewn 344%, stapled 249%, hybrid 280%). Stapled and hybrid sutures had fourfold higher Young's modulus as compared to handsewn sutures (handsewn 1.779 MPa, stapled 7.374 MPa, hybrid 6.964 MPa). Handsewn and hybrid sutures showed significantly higher dissipated specific energy (handsewn 0.99 mJ-mm3, stapled 0.73 mJ-mm3, hybrid 1.35 mJ-mm3). CONCLUSION Stapled sutures can resist high loads, but are less deformable and rigid than handsewn suture. This suggests a safer employment in case of small defects or diastasis (< W1 in accord to EHS classification), where the presumed tissutal displacement is minimal. Oversewing a stapled suture improves its efficiency, becoming crucial in case of larger defects (> W1 in accord to EHS classification) where the expected tissutal displacement is maximal. Hybrid sutures seem to be a good compromise.
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Affiliation(s)
- Enrico Lauro
- Department of General Surgery, St. Maria Del Carmine Hospital, Rovereto, Italy.
| | - Ilaria Corridori
- Laboratory for Bioinspired, Bionic, Nano, Meta Materials and Mechanics, Department of Civil, Environmental and Mechanical Engineering, University of Trento, Trento, Italy
- BIOtech Center for Biomedical Technologies, Department of Industrial Engineering, University of Trento, Trento, Italy
| | - Lorenzo Luciani
- Robotic Unit and Department of Urology, Santa Chiara Hospital, Trento, Italy
| | - Alberto Di Leo
- Department of General Surgery, San Camillo Hospital, Trento, Italy
| | - Alberto Sartori
- Department of General Surgery, Montebelluna-Castelfranco Veneto Hospital, Treviso, Italy
| | - Jacopo Andreuccetti
- Department of General Surgery 2^, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Diletta Trojan
- Fondazione Banca dei Tessuti Treviso FBTV, Treviso, Italy
| | - Giovanni Scudo
- Department of General Surgery, St. Maria Del Carmine Hospital, Rovereto, Italy
| | - Antonella Motta
- BIOtech Center for Biomedical Technologies, Department of Industrial Engineering, University of Trento, Trento, Italy
| | - Nicola M Pugno
- Laboratory for Bioinspired, Bionic, Nano, Meta Materials and Mechanics, Department of Civil, Environmental and Mechanical Engineering, University of Trento, Trento, Italy.
- School of Engineering and Material Science, Queen Mary University of London, London, UK.
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Raftopoulos Y, Rajkumar S, Davidson E, Papasavas P. Prospective Randomized Comparison of Linear Endostaplers During Laparoscopic Sleeve Gastrectomy. Obes Surg 2022; 32:3472-3480. [PMID: 35974292 DOI: 10.1007/s11695-022-06240-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/05/2022] [Accepted: 08/09/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE The development of Laparoscopic Linear Endostaplers (LLES) is crucial in minimally invasive approaches in bariatric surgery, but there have been very few published studies comparing 6-row LLES in Laparoscopic Sleeve Gastrectomy (LSG). The objective of this study was to compare two 6-row LLES in LSG. METHODS A total of 60 patients were prospectively randomized to undergo LSG with either Medtronic Endo GIA™ Tri-Staple technology (MTS) or AEON ™ Endostapler(Lexington Medical) LLES. The measured parameters included patient demographics, comorbidity indices, LLES and specimen characteristics, postoperative symptoms, hospital stay, and total adverse events (AEs). Intraoperative bleeding was evaluated using five laparoscopic and corresponding endoscopic images of staple line before clip application, compared with a 1-5 Visual Analogue Scale (VAS), assessed by an independent bariatric surgeon who was blinded to the LLES used. Images of all cases were reviewed on the same day to increase test-retest reliability. RESULTS Both groups were similar in patient demographics. Compared to MTS, AEON LLES group had significantly lower bleeding VAS scores in 4/5 laparoscopic images (pre-pyloric: 1.7 ± 0.7 vs. 2.36 ± 0.76, p = 0.0007, mid-sleeve: 1.46 ± 0.62 vs. 1.86 ± 0.68, p = 0.019, proximal sleeve: 1.6 ± 0.77 vs. 2.0 ± 0.83, p = 0.038, gastro-esophageal junction: 1.43 ± 0.67 vs. 1.86 ± 0.77, p = 0.014) and 3/5 endoscopic images (pre-pyloric: 1.56 ± 0.56 vs. 2.36 ± 0.76, p = 0.006, incisura: 1.66 ± 0.54 vs. 2.0 ± 0.52, p = 0.021, mid-sleeve: 1.63 ± 0.49 vs. 2.0 ± 0.45, p = 0.005). There was no statistical difference in other parameters. CONCLUSION Both devices were equally safe and effective in terms of LLES and specimen characteristics, patient symptoms, hospital stay, and AEs. Bleeding VAS scores were significantly lower, favoring the AEON LLES.
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Affiliation(s)
- Yannis Raftopoulos
- Weight Management Program, Holyoke Medical Center, Holyoke, MA, 01040, USA
| | - Shruthi Rajkumar
- Weight Management Program, Holyoke Medical Center, Holyoke, MA, 01040, USA.
| | - Elana Davidson
- Weight Management Program, Holyoke Medical Center, Holyoke, MA, 01040, USA
| | - Pavlos Papasavas
- Medical and Surgical Weight Loss Center, Hartford Hospital, Hartford, CT, 06106, USA
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Small bowel obstruction following laparoscopic Roux-en-Y gastric bypass: is it always necessary to operate? A 5-year, high volume center experience. Langenbecks Arch Surg 2021; 406:1839-1846. [PMID: 34259917 DOI: 10.1007/s00423-021-02262-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aims to describe the incidence, associated factors, etiology, and management of small bowel obstructions following laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS A retrospective analysis was conducted between January 15 and December 19 using the surgery database of our hospital. Included LRYGB patients were those that evolved with a prolonged length of stay; readmission; emergency room consult; and re-intervention due to small bowel obstruction (SBO) related symptoms with compatible radiological or intraoperative findings. The LRYGB technique implied an antecolic alimentary limb reconstruction and systematic closure of mesenteric defects. Descriptive and analytical statistics were carried out, using a parametric or non-parametric approach as needed. RESULTS Nine hundred forty-one LRYGB were performed. 9.9% were revisional surgeries of patients with a laparoscopic sleeve gastrectomy. During the study period, 36 SBOs occurred, representing 3.8% of operated patients, with no mortality. 58.3% had successful non-operative management, while 41.7% required surgical exploration, of which 73.3% were treated laparoscopically and 20% needed conversion to open surgery. Etiologies of SBO were jejuno-jejunostomy (JJO) related stenosis (22, 61.1%), internal hernias (6, 16.7%), adherences (3, 8.3%), and other diagnoses (5, 13.9%). Regarding JJO stenosis and internal hernias, median time to diagnosis was 8 days (IQR 7-11) and 12 months (IQR 8.7-16) respectively. Previous sleeve gastrectomy, age, or sex was not associated to the incidence of small bowel obstruction. CONCLUSIONS LRYGB is safe when performed by experienced surgeons. SBO due to internal hernias were scarce in this series. JJO stenosis could explain most cases of SBO; under this diagnosis, non-surgical management was successful frequently.
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Redmann JG, Lavin TE, French MS, Broussard TD, Lapointe-Gagner M. Improving Hemostasis in Sleeve Gastrectomy With Alternative Stapler. JSLS 2021; 24:JSLS.2020.00073. [PMID: 33447003 PMCID: PMC7791089 DOI: 10.4293/jsls.2020.00073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background: Staple line bleeding can be a major intra-operative complication during laparoscopic sleeve gastrectomy, requiring reinforcing interventions that may diminish the integrity of the staple line and put patients at risk for postoperative hemorrhage or leak. To improve outcomes associated with surgery, surgeons may benefit from an alternative stapler that produces a drier staple line and requires less staple line manipulation. Methods: Sixty consecutive laparoscopic sleeve gastrectomy procedures were performed by three surgeons; 30 sleeves using the AEON™ Endostapler on THICK MODE and 30 using the Echelon Flex™ Powered Stapler with pulse technique. Stapler performance was measured by incidence and degree of staple line bleeding. Images of the first firing and fundus were taken with the laparoscope 10 seconds after the final firing. Images were evaluated by a third-party blinded evaluator and given a “bleeding score,” a qualitative measure of intra-operative staple-line bleeding (1 = no bleeding to 5 = profuse bleeding). Results: The AEON™ Endostapler demonstrated a lower mean (± standard error) “bleeding score” versus the Echelon Flex™ (2.1 ± 0.1 vs. 2.6 ± 0.1; p = 0.01). The AEON™ Endostapler had 15 cases (50%) with no bleeding at the fundus; the Echelon Flex™ had 7 cases (23%) with no bleeding at the fundus. The AEON™ Endostapler had 0 cases (0%) with profuse bleeding; the Echelon Flex™ had 2 cases (7%) with profuse bleeding. Conclusion: The AEON™ Endostapler is a significantly drier alternative to the Echelon Flex™ Powered Stapler, producing a much drier staple line and decreasing the need for other bleeding control methods.
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Dargent J, Lepage S, Carandina S, Blanc P, Breton C. Étude des agrafeuses laparoscopiques linéaires de la société REACH Surgical sur la sleeve gastrectomie en France. ACTA ACUST UNITED AC 2020. [DOI: 10.3166/obe-2020-0089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Les interventions bariatriques laparoscopiques faisant usage d’agrafeuses linéaires sont devenues de plus en plus populaires en France, et représentent plus de 90 % du nombre total des procédures bariatriques, soit plus de 36 000 annuellement. La sleeve gastrectomie et le by-pass gastrique sont les plus réalisés aujourd’hui. Concernant les dispositifs concurrents des deux sociétés les mieux établies (Medtronic et Ethicon), il y a un manque de résultats publiés. Un essai a été conduit avec une nouvelle génération d’agrafeuses linéaires endoscopiques créées par une société chinoise (REACH Surgical) dans quatre centres en France (Lyon, Bourgoin, Toulon et Saint-Étienne) et cinq opérateurs différents. Trente-six sleeve gastrectomies ont été réalisées de octobre 2019 à février 2020 (34 primaires et deux secondaires), 32 femmes et quatre hommes, âge moyen : 42 ans, poids : 112 kg, IMC : 40,4 kg/m2. De 0 à 5, la note moyenne sur l’ergonomie a été de 4, et pour la sécurité 4,5. Il n’y a pas eu d’événements indésirables à 48 heures, et un à J4 (abcès sous-phrénique, pas de fistule digestive). L’impression générale a été celle d’un dispositif sûr et efficace.
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