title: Pressure tolerance of newly constructed staple lines in sleeve gastrectomy and duodenal switch.
abstract: BACKGROUND
  Many bariatric surgeons elect to pressure test the newly constructed staple lines in sleeve gastrectomy and duodenal switch procedures as a means of intraoperatively detecting leaks. The pressure tolerance of these fresh staple lines has not been well studied in a clinical setting.
  
  
  METHODS
  This is a retrospective institutional review board-approved study that analyzed resected stomachs immediately after resection during a bariatric operation performed using sleeve gastrectomy or biliopancreatic diversion with duodenal switch. Resected stomachs were connected to a normal saline infusion and manometric pressure device for determining the maximum stomach capacity, the leak pressure, and the location of the first leak.
  
  
  RESULTS
  Thirty patients (9 underwent biliopancreatic diversion with duodenal switch and 21 underwent sleeve gastrectomy) met the inclusion criteria (mean age of 44.7 years, 63.3% female) with a mean body mass index of 44.1 that was higher with biliopancreatic diversion (51.3 vs 41.0, P = .001) and a mean weight loss of 83 lb (a body mass index decrease of 13.4; median follow-up, 307 days). The leak volume of the resected stomach averaged 1,478 mL (range 1,100 to 2,200) with an average pressure of 25.6 cm H2O (range 12 to 60). The volume and leak pressures were equivalent despite the operative approach (P = .79 and .32, respectively), and there was no difference in the location of the leak (staple line or intrinsic stomach) based on volume or pressure (P = .246 and .131, respectively), with 50% of leaks occurring on the staple lines.
  
  
  CONCLUSIONS
  The fresh staple lines in vertical sleeve gastrectomy and duodenal switch show burst strength well in excess of any intragastric pressures likely to be created by brief intraoperative leak checks via air instilled by an orogastric tube or intraoperative endoscopy. Leak testing is not likely to create iatrogenic damage to properly constructed fresh staple lines in these procedures.
authors.affiliation: Department of General Surgery, Madigan Army Medical System, Madigan Health System, 9040 Fitzsimmons Drive, Tacoma, WA 98431, USA. mwcausey@msn.com
authors.forename: Marlin Wayne
authors.initials: MW
authors.lastname: Causey
authors.forename: Emilie
authors.initials: E
authors.lastname: Fitzpatrick
authors.forename: Preston
authors.initials: P
authors.lastname: Carter
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000175:diagnosis* / Q000517:prevention & control; D004386:Duodenum / Q000502:physiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007430:Intraoperative Care / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011312:Pressure; D012189:Retrospective Studies; D033081:Shear Strength; D013270:Stomach / Q000502:physiology / Q000601:surgery*; D017792:Surgical Stapling; D013718:Tensile Strength; D016896:Treatment Outcome; D015431:Weight Loss