title: Evaluation of a Powered Stapler System with Gripping Surface Technology on Surgical Interventions Required During Laparoscopic Sleeve Gastrectomy.
abstract: BACKGROUND
  Transection of gastric tissue during laparoscopic sleeve gastrectomy (LSG) can be challenging. Reinforcing the staple line may decrease the incidence of issues requiring intervention.
  
  
  METHODS
  The objective of this study was to compare the number of intraoperative surgical interventions for a surgical stapler and reload system with Gripping Surface Technology (GST) to standard reloads in patients who underwent LSG. Patients who underwent elective LSG were enrolled. The study was conducted in two stages. For Stage 1, procedures were performed using a powered stapler and standard reloads. For Stage 2, a reload system with GST was used. The primary endpoint was surgical interventions for bleeding and/or staple line issues during transection of the greater curvature of the stomach. Propensity score matching was applied to create two groups similar in baseline characteristics and risk factors.
  
  
  RESULTS
  A total of 111 subjects were enrolled across four centers. Propensity-matched procedures were completed with the standard (n = 38) or GST reloads (n = 38). The mean number of interventions in the standard group was 1.9 (1.29) versus 1.1 (1.45) in the GST group. Nonparametric comparisons were statistically significant, indicating a reduction in the distribution of interventions for GST subjects (P = .0036 for matched pair data). Tissue slippage during transection was low for both groups. Intraoperative leak testing was negative in all procedures, and no procedures were converted to open.
  
  
  CONCLUSIONS
  Use of the GST stapling system reduces the need for staple line interventions in LSG. Both stapling systems had an acceptable safety profile.
authors.affiliation: 1 Ethicon, Inc. , Cincinnati, Ohio.
authors.forename: Elliott
authors.initials: E
authors.lastname: Fegelman
authors.affiliation: 1 Ethicon, Inc. , Cincinnati, Ohio.
authors.forename: Susan
authors.initials: S
authors.lastname: Knippenberg
authors.affiliation: 1 Ethicon, Inc. , Cincinnati, Ohio.
authors.forename: Michael
authors.initials: M
authors.lastname: Schwiers
authors.affiliation: 2 Division of Bariatric Surgery, Department of Surgery, Carolinas Healthcare System , Charlotte, North Carolina.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Stefanidis
authors.affiliation: 2 Division of Bariatric Surgery, Department of Surgery, Carolinas Healthcare System , Charlotte, North Carolina.
authors.forename: Keith S
authors.initials: KS
authors.lastname: Gersin
authors.affiliation: 3 Division of Bariatric and Metabolic Surgery, Greenville Health System, University of South Carolina School of Medicine-Greenville , Greenville, South Carolina.
authors.forename: John D
authors.initials: JD
authors.lastname: Scott
authors.affiliation: 4 Department of General Surgery, Wake Forest University School of Medicine , Winston Salem, North Carolina.
authors.forename: Adolfo Z
authors.initials: AZ
authors.lastname: Fernandez
mesh_terms: D000328:Adult; D005260:Female; D005743:Gastrectomy / Q000295:instrumentation* / Q000379:methods; D006470:Hemorrhage / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D013528:Surgical Staplers; D017792:Surgical Stapling / Q000009:adverse effects / Q000295:instrumentation*
keywords: laparoscopic sleeve gastrectomy; powered stapler; staple line interventions