title: A Thickness Calibration Device Is Needed to Determine Staple Height and Avoid Leaks in Laparoscopic Sleeve Gastrectomy.
abstract: BACKGROUND
  Leaks after sleeve gastrectomy (SG) may be due to a mismatch between staple height and tissue thickness. The aim of this study was to determine the range of gastric thicknesses in three areas of stapling.
  
  
  METHODS
  SG was performed using a 40-Fr suction calibration system 4 cm from the pylorus. Measurement of combined gastric walls was accomplished with an applied pressure of 8 g/mm(2) on the fundus, midbody, and antrum.
  
  
  RESULTS
  We enrolled 26 SG patients (15 women, 11 men; mean age 36.8 years). Body mass index (BMI) averaged 45.3 kg/m(2) overall, 44.7 kg/m(2) for males and 45.7 kg/m(2) for females. Although male patients had a thicker stomach antrum than female patients (3.12 vs. 3.09 mm), the midbody (2.57 vs. 3.09 mm) and proximal areas (1.67 vs. 1.72 mm) were thicker in female patients. However, some maximum fundus thicknesses were up to 2.83 mm in females and 2.28 mm in males. Some antra were as thick as 4.07 mm in females and 5.39 mm in males. Also, men had a longer average staple line (22.95 vs. 19.90 cm).
  
  
  CONCLUSIONS
  Because of the range of gastric thicknesses, a single staple height cannot be used to appose the full range of gastric wall thicknesses without potentially causing necrosis or poor apposition. To help avoid leaks, a thickness calibration device is needed to determine correct staple height.
authors.affiliation: Boehringer Laboratories, LLC, Phoenixville, PA, USA. rhuang@boehringerlabs.com.
authors.forename: Rose
authors.initials: R
authors.lastname: Huang
authors.affiliation: Department of Surgery, Hospital Du Sacre Coeur, Montreal, QC, Canada. gagner.michel@gmail.com.
authors.forename: Michel
authors.initials: M
authors.lastname: Gagner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000592:standards; D057868:Anastomotic Leak / Q000517:prevention & control*; D015992:Body Mass Index; D002138:Calibration; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods / Q000592:standards; D005748:Gastric Fundus / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods / Q000592:standards; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000473:pathology / Q000601:surgery*; D009929:Organ Size; D013270:Stomach / Q000601:surgery; D017792:Surgical Stapling / Q000295:instrumentation* / Q000379:methods / Q000592:standards*; D055815:Young Adult
keywords: Bleeding; Reloads; Sleeve gastrectomy; Stapler; Thickness