Bariatric Times - Supplement A - Covidien - (Page 17)

THE 2007 INTERNATIONAL CONSENSUS SUMMIT ON SLEEVE GASTRECTOMY Laparoscopic Sleeve Gastrectomy: Prevention and Treatment of Bleeding by ALFONS POMP, MD, FACS AUTHOR AFFILIATIONS: Dr. Pomp is Professor of Surgery, Weill Medical College of Cornell University, New York, New York. ADDRESS CORRESPONDENCE TO: Alfons Pomp, MD, FACS, 525 East 68th Street, Box 294, New York, NY 10065; Phone: 212-746-5294; Fax: 212-746-5236; E-mail: apomp@med.cornell.edu There are four major complications following sleeve gastrectomy, severe gastroesophageal reflux, internal hemorrhage, extra-gastric hemorrhage, and staple-line leaks. This article will discuss the prevention and treatment of bleeding. The stomach does not have the same thickness at the angle of His as it does more distally at the antrum. Moreover, there are also varying thicknesses of the stomach from the greater curvature of the stomach toward the right side of the stomach. Males have a tendency to have thicker gastric walls than females, but when tissues are compared, the difference is only about 0.3mm. All surgical stapling is essentially a compromise between tissue compression that creates ischemia while approximating tissue or allowing tissue viability and thus hemorrhage. Our stapling technology is still based on studies by the Scientific Institute for Surgical Devices and Instruments of the USSR, where surgical staplers originated before Dr. Mark Ravitch brought them to the US. The Information For Users (IFU) in the stapler package insert defines only vaguely what types of different loads are directed to tissue that compresses to what type of diameter. Stapling biomechanics are important to understand. Human tissue is made of liquids and solids, and is thus defined as biphasic. When you apply the stapler to tissue, you use force to bring the jaws together, and during this compression part of the tissue is actually squeezed out of the device. [JUNE This is an elongation force. However, once you fire the closed stapler, this action is called applied distraction. Furthermore, once the tissue is actually brought together, it then partly relaxes, so it is actually easier to cut after it has been held together for a little bit of time, and this is called stress relaxation. Some stapler mechanics are such that you increase the compression as you fire, and there is actually a tissue shear or a tearing that can occur. Every one of these points is important in trying to prevent hemorrhage or leaks when utilizing applying a stapler. Sleeve gastrectomy is unique among weight loss surgeries that involve transection of the stomach or bowel in that there is no anastomosis. Given the mechanics of stapling, there is little, if any, chance that there will be an SUPPLEMENT A] 2008, Bariatric Times 17

Table of Contents Feed for the Digital Edition of Bariatric Times - Supplement A - Covidien

Bariatric Times - Supplement A - Covidien Contents Laparoscopic Sleeve Gastrectomy: From Magenstrasse And Mill To Sleeve Sleeve Gastrectomy Provides Resoultion of Type-2 Diabetes Without Duodenal Exclusion The Relationship Bewtween The Resected Remnant And Weight Loss Laparoscopic Sleeve Gastrectomy: Results After Two And Five Years Laparoscopic Sleeve Gastrectomy As An Initial Weight Loss Procedure For High-Risk Patients With Morbid Obesity Three-Year Results Of Laparoscopic Sleeve Gastrectomy In The Treatment Of Morbid Obesity In Korea Laparoscopic Sleeve Gastrectomy: Nutritional Concerns And PostOperative Dietary Care Laparoscopic Sleeve Gastrectomy: Prevention And Treatment Of Bleeding Prevention And Treatment Of Gerd/Hiatal Hernia And Stenosis Associated With Sleeve Gastrectomy Laparoscopic Revisions Of Sleeve Gastrectomy Survey Results

Bariatric Times - Supplement A - Covidien

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