The Double Application of the TA-90B Four-row Stapler and Pouch Formation: Eight Rows are Safe and Effective in Roux-en-Y Gastric Bypass.
Staple-line failure in gastroplasty means eventual weight re-gain in most cases. In gastric bypass this can be disastrous, with a high risk of stomal ulcer formation and reflux esophagitis, as well as weight re-gain. Because of this, total transaction of the two pouches has become more popular, eliminating the staple-line altogether, and thereby preventing any possibility of staple-line failure. However, there is a higher risk of leaks and the two pouches can fistulize into one another, producing the equivalent of a staple-line failure. From July 1987 to August 1991, 350 patients had a Roux-en-Y gastric bypass (RYGBP) with a single application of the TA-90B Autosuturetrade mark instrument, with four known staple-line failures. From August 1991 to May 1993, 210 patients received a double application of the TA-90B four row Autosuturetrade mark stapler. There are no known staple-line failures to date and no leaks, with quite adequate weight loss. This technique has proven safe and effective in the short run.
Jones
KB
Departments of Surgery, Physicians and Surgeons Hospital and T.E. Schumpert Memorial Medical Center, Shreveport, LA, 71101, USA.