Self-locking first stitch in suture reinforcement of the laparoscopic gastric sleeve

摘要

Dear Editor, Sleeve gastrectomy involves the creation of small gastric reservoir based on the lesser curvature of the stomach, which is fashioned by a longitudinal gastrectomy that preserves the antrum and pylorus together with its vagal innervation. Recently, laparoscopic sleeve gastrectomy (LSG) is viewed as a multipurpose bariatric procedure that restricts the stomach size to induce satiety and resects fundal ghrelin-producing cells to decrease appetite. The incidence of perioperative major and minor complications in the literature is approximately 5 and 11%, respectively. Staple line complications like bleeding or gastric leak can have catastrophic results in patients who underwent LSG. Both complications can lead to significant morbidity and even death. When bleeding is identified, conservative management of stopping anticoagulation and appropriate fluid or blood resuscitation is usually sufficient in most of cases. Management of the leak, however, is usually difficult and may include conservative treatment with the placement of endoscopic stents or may require reoperation that includes peritoneal draining and placement of drainage tubes or even total gastrectomy. Therefore, any technique that can reduce the likelihood of these complications would be of tremendous benefit to the field of bariatric surgery. As a result, a continuous effort to improve the performance of stapling devices by reinforcing the staple line is underway.