The science of stapling and leaks.
Staple-line leaks represent an unwanted, yet seemingly unavoidable, complication of stapling associated with bariatric surgery. Although, "folk legends" abound as to precluding leaks, little has been written based on basic research and understanding of stapling mechanics. This article reviews the history of stapling and discusses the implications of understanding the biomechanics of stapling living tissue. Finally, three leak studies evaluating ways to optimize staple-line strength are presented, and a large bariatric clinical series is reviewed.
Baker
Randal S
RS
Michigan Medical Center for Health Excellence, Grand Rapids, MI 49546, USA. rbaker@mmpc.com
Foote
James
J
Kemmeter
Paul
P
Brady
Randall
R
Vroegop
Todd
T
Serveld
Matt
M
D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D000818:Animals; D002102:Cadaver; D004195:Disease Models, Animal; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D018570:Risk Assessment; D017792:Surgical Stapling / Q000009:adverse effects* / Q000379:methods; D013537:Sutures; D013552:Swine; D013718:Tensile Strength