Background

As the sleeve gastrectomy has increased in popularity becoming the most performed bariatric surgery, the technical aspects of the operation have been critiqued in hopes of decreasing complication rates. The most serious post-operative complications include staple line leaks, for which current research has demonstrated a leak rate of 1-2%, and gastric sleeve stenosis or strictures, which has an incidence of up to 4%. These complications, depending on the post-operative time frame, are likely caused by technical errors during surgery and can lead to symptoms of dysphagia, reflux, nausea, and vomiting. Although difficult to study, many articles in the literature support the correlation between the surgical technique of creating the sleeve and post-operative complications. The traditional method of multiple staple fires alongside a bougie allows for a greater margin for error which can lead to kinking or twisting of the staple line. Subsequently, these areas of staple line irregularity can create high pressure zones and partial obstructions contributing to post-operative symptoms and complications. By utilizing the bariatric clamp or the single-fire 230mm stapler, the degrees of freedom are decreased resulting in less variability of the shape of the sleeve. This technique allows for the removal of the fundus and body without distorting the remaining stomach's anatomy, while still producing a curved sleeve. Although our one-year post-operative data is still being accrued, there have been no staple line leaks or sleeve stenosis to date in our 230mm stapler group.