Abstract:

The sleeve gastrectomy has been accepted as a primary bariatric procedure. One of the most feared complications is staple line leakage. It is important to use the right staple sizes to minimize the risk of leak. Knowledge of gastric thickness is important. The goal of this study was to measure the thickness of the gastric wall after elimination of the gastric folds in the mucosa. An electronic thickness gauge was developed that measured the anterior and posterior wall of the fresh stomach specimen together at 5 points at a pressure based on the finger pressure necessary to flatten the gastric folds. Thirty-three fresh specimens were measured. The mean compression pressure was 714 grams, and no difference was found between the 5 measure points. There was a significant difference in stomach wall thickness. The gastric antrum was more than 1 mm thicker than the fundus. No difference was found between BMI groups <40Kg/m2, 40-50Kg/m2, or >50Kg/m2. No bleeding occurred, leakage occurred in 1 case. There is a significant difference in thickness of the stomach wall between the gastric fundus and the antrum. A pressure 2.5 times lower than applied in prior studies was necessary to achieve full tissue compression. Choosing thinner staple sizes for the gastric fundus might be the optimal technique for compression. However, there are several additional factors that influence the risk of staple line leaks.

Authors:

Pim W.J. van Rutte, MD, Surgeon in Training, Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands, Bertus J. Naagen, MSc, Lab Manager, Faculty of Industrial Design, Technical University of Delft, Delft, The Netherlands, Marinus Spek, BSc, Instrument Maker, Leiden Instrument Makers School, Leiden, The Netherlands, Jack J. Jakimowicz, MD, PhD, FRCS, EdD, Professor of Safety in Health Care, Faculty of Industrial Design, Technical University of Delft, Delft, The Netherlands, Simon W. Nienhuijs, MD, PhD, Surgeon, Department of Surgery, Catharina Hospital , Eindhoven, The Netherlands

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