title: Double Application of TA-90 B Four-Row AutoSuture(c) Stapling Instrument: A Safe, Effective Method of Staple-line Production Indicated by Follow-up GI Series.
abstract: BACKGROUND: Controversy continues, concerning the best method of isolating upper and lower gastric pouches in Roux-Y gastric bypass. This paper reports a technique used from August 1991 through May 1996, in which there was a double application of the TA-90 B Four-Row AutoSuture Stapling Instrument to form the proximal gastric pouch. Because of a significant staple-line failure rate historically, many are separating the pouches. However, due to recent reports of gastro-gastric fistula formation when pouch separation is done, a second look has been taken at stapling the division without separation of the pouches. METHODS: There were 650 patients in this series, and 160 asymptomatic patients 1-4 years postoperatively agreed to have limited upper series. RESULTS: Only one of this group had staple-line failure. Failures were seen in four of 19 symptomatic patients with dyspepsia or rapid weight regain. Putting these two groups together, our staple-line failure rate has been less than 1% using this technique. CONCLUSION: Whether stapling in continuity or dividing the stomach, the two methods appear to be equally effective with comparable morbidity. Patients with staple-line failure or gastro-gastric fistulae will ultimately be forced by their symptoms of rapid weight regain and/or peptic ulcer disease and reflux esophagitis to return for follow-up. Asymptomatic patients very rarely have a connection between upper and lower pouches, and routine follow-up upper GI series are not indicated.
authors.affiliation: Departments of Surgery and Radiology, Schumpert Memorial Medical Center, Shreveport, LA, 71101, USA.
authors.initials: KB
authors.lastname: Jones
authors.initials: W
authors.lastname: Homza
authors.initials: PW
authors.lastname: Peavy
authors.initials: LH
authors.lastname: Williams
authors.initials: PB
authors.lastname: Leopard
authors.initials: L
authors.lastname: Mastrodomineco
authors.initials: T
authors.lastname: McCook
authors.initials: EE
authors.lastname: Patterson
authors.initials: WM
authors.lastname: Wilder
authors.initials: WB
authors.lastname: Gallman