Bipolar sealing increases mesenteric reach during bowel transection compared with stapled division: clinical evidence and laboratory support in a porcine model.
BACKGROUND
The ideal technique for mesenteric division to create tension-free anastomoses has not been defined. For patients undergoing Roux-en-Y gastric bypass (RYGB), the mesenteric division technique was changed from stapler to bipolar sealing using LigaSure for cost reasons. This study aimed objectively to assess the impact of the mesenteric division method on mobilization length of the Roux limb in an animal model. Clinical complications related to Roux limb tension also were analyzed in the authors' population of RYGB patients.


METHODS
Bowel and mesenteric divisions were performed in a porcine model. Four pigs received six to eight mesenteric divisions each. Steady force was applied for 1 min. The distances between the divided limbs of bowel were compared. To assess the clinical impact with RYGB patients, anastomotic complications were analyzed before and after incorporation of bipolar sealing in the authors' practice.


RESULTS
In the porcine model, the length of mesenteric stretch averaged 93.7 mm with stapled division and 109 mm with bipolar sealing (p = 0.021). From a laparoscopic RYGB population, 160 patients with stapled division were included, all of whom were at least 1 year beyond their surgery. The study analyzed 792 patients with bipolar sealing for leak or bleeding and included 479 bipolar sealed patients more than 1 year beyond their surgery for analysis of their strictures. No difference in bleeding or leaks was found between these groups. The stricture rate was significantly different, with seven strictures after stapled division (4.37%) compared with one stricture after bipolar sealing (0.2%; p = 0.001).


CONCLUSIONS
Bipolar sealing for mesenteric division is superior to stapling for optimization of enteric limb length at constant tension in a laboratory model. Clinical evidence supports this hypothesis with patients undergoing RYGB surgery by a decrease in the complications that can arise from Roux limb tension.
Manson
Roberto J
RJ
Department of Surgery, Duke University Medical Center, 3116 N. Duke Street, Durham, NC 27704, USA.
Pryor
Aurora D
AD
D000818:Animals; D003251:Constriction, Pathologic; D004564:Electrocoagulation / Q000009:adverse effects / Q000295:instrumentation; D015390:Gastric Bypass / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007422:Intestines / Q000601:surgery*; D008643:Mesentery / Q000503:physiopathology*; D017792:Surgical Stapling / Q000009:adverse effects; D013552:Swine