A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional
Issue link: https://bariatrictimes.epubxp.com/i/69664
CHECKLIST IN LAPAROSCOPIC SLEEVE GASTRECTOMY Part 1: SURGICAL TECHNIQUE A green load being used for transection of the stomach during the sleeve gastrectomy procedure. EXPERT COMMENTARY John Jorgensen, MB, BS, FRACS, MS St. George Private Hospital, Sydney, Australia stapler. Very slow application of the stapler (i.e., waiting at least 15 seconds after stapler closure before firing) is recommended to allow for tissue modelling before firing. In terms of staple height, there is a growing trend to use staples taller than 1.5mm to minimize the chance of tissue crush and subsequent staple line failure. At the 2011 SG consensus meeting, the panel agreed that green loads were the smallest acceptable staple heights at the antrum and from the gastric body upwards blue or green loads were recommended. There was an increasing trend to use taller staples, green load or taller, in these areas. For revision cases, and when adding buttress material, the green load or taller should be the choice. T Wide range of cartridges for thin to thick tissue, all fitting through a 12mm trocar. Transection of the stomach starts 2–6cm from the pylorus. Green load or greater should be used. It is important that the assistant exercises a mild and symmetric lateral traction. FIRST FIRING AND WHERE TO START THE TRANSECTION Transection should begin 2–6 cm from pylorus EXPERT COMMENTARY Alfons Pomp, MD, FACS, FRCSC Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York T here are two critical points to be made in regard to first firing and starting the transection in a sleeve gastrectomy procedure. First, appropriate stapler size should be chosen to ensure adequate tissue apposition with hemostasis and to minimize serosal tearing close to the staple line; usually this requires a green load (2.0mm close height) or greater, as agreed in the SG consensus meeting. Second, although not addressed in the SG consensus statement, in my opinion, the orientation (angle from the greater curve) of the first stapler line is also important, particularly if this is a 60mm long cartridge, as the first firing should not compromise the width of the sleeve near the incisura. [JUNE 2012, SUPPLEMENT B] Bariatric Times B3 he sleeve gastrectomy involves a long staple line in a high- pressure tube. Uncomplicated healing depends, in part, on the correct choice of staple height and correct use of the STAPLE HEIGHT Use staples of at least 1.5mm closed height (e.g., blue load) on all steps If buttressing, use staples of at least 2.0mm closed height (e.g., green load) When resecting the antrum, surgeon should never use any staple with closed height less than that of a green load (2.0mm)