Bariatric Times

Spotlight on Technology December 2014

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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Supported by: P O T L I G H T on T E C H N O L O G Y S V O L U M E 1 1 , N U M B E R 1 2 D E C E M B E R 2 0 1 4 • S U P P L E M E N T C A BULLETIN HIGHLIGHTING BARIATRIC AND METABOLIC SURGICAL PRODUCTS Q: Dr. Nicholson, please share your insights on why one should use buttressing material. A: With the rise of laparoscopic sleeve gastrectomy (LSG), the need for buttressing material continues to rise. I find value in its use in bariatric and metabolic procedures and feel there are many important considerations when choosing a buttressing material. First, the use of buttressing material ensures increased strength in the staple line. Although there is some debate as to whether increasing staple line strength is necessary (given the current stapling technology), in my practice, I do find that it is necessary, especially in LSG procedures. In LSG, the stomach is more narrow and thus the pressure system is much higher as compared to other weight loss procedures. In the event that a patient is noncompliant and eats too soon after surgery, the staple line may be further stressed. For these reasons, I believe there is an added degree of comfort when you reinforce the staple line. Next, in my experience, the use of buttressing material minimizes bleeding along the staple line. This is significant because not only can bleeding lead to significant postoperative complications, but also when bleeding is present, it is difficult to visualize the procedure. With buttressing material employed, the bleeding is easily isolated visually as well as from a surgical intervention standpoint (i.e., the source can be accurately addressed with minimal extraneous trauma). With the buttressing material providing strength to the staple line, this enables easier manipulation versus native tissue and non- The Value of Using Buttressing Material for Staple Line Reinforcement in Bariatric and Metabolic Procedures: Two Perspectives Nick Nicholson, MD Dr. Nicholson is Medical Director, Nicholson Clinic for Weight Loss Surgery, Dallas, Texas T h e h i g h - v o l u m e s u r g e o n L aparoscopic sleeve gastrectomy (LSG) continues to gain in popularity as a primary bariatric and metabolic surgical procedure. Numerous studies have supported the safety and efficacy of LSG with leak rates being around 1 to 5 percent. 1–5 Although infrequent, staple line leaks are a serious and life threatening complication. There are numerous publications regarding diagnosis and treatment of post-LSG leaks; however, there is little information in the literature on total costs to the hospital and patient when a leak occurs. Bariatric Times interviewed two surgeons on the value of using buttressing material for staple line reinforcement in bariatric and metabolic procedures. Here, we present two perspectives. First, Dr. Nick Nicholson, a high-volume surgeon from Texas, shares his clinical insights. Next, Dr. Eric Bour, a bariatric surgeon and hospital CEO, discusses the financial benefits of having GORE ® SEAMGUARD ® Bioabsorbable Staple Line Reinforcement in the armamentarium for LSG procedures. References 1. Márquez MF, Ayza MF, Lozano RB, et al. Gastric leak after laparoscopic sleeve gastrectomy. Obes Surg. 2010 Sep;20(9):1306- 11. PMID: 20574787. 2. Knapps J, Ghanem M, Clements J, Merchant AM. A systematic review of staple-line reinforcement in laparoscopic sleeve gastrectomy. JSLS. 2013;17(3):390–399. 3. Moon Han S, Kim WW, Oh JH. Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obes Surg. 2005;15:1469–475. 4. Melissas J, Koukouraki S, Askoxylakis J, et al. Sleeve gastrectomy: A restrictive procedure? Obes Surg. 2007;17:57–62. 5. Sarkhosh K, Birch D, Sharma A, Karmali S. Complications associated with laparoscopic sleeve gastrectomy for morbid obesity: a surgeon's guide. Can J Surg. 2013;56(5):347–352.

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