DOUBLE APPLICATION OF TA-90-B 4-ROW AUTOSUTURE(R) STAPLING INSTRUMENT- A SAFE, EFFECTIVE METHOD OF STAPLE-LINE PRODUCTION INDICATED BY FOLLOW-UP GI SERIES

Background: Controversy continues concerning the best method of isolat ing upper and lower gastric pouches in Roux-Y gastric bypass. This pap er reports a technique used from August 1991 through May 1996, in whic h there was a double application of the TA-90 B Four-Row AutoSuture(R) Stapling Instrument to form the proximal gastric pouch. Because of a significant staple-line failure rate historically, many are separating the pouches. However, due to recent reports of gastro-gastric fistula formation when pouch separation is done, a second look has been taken at stapling the division without separation of the pouches. Methods: There were 650 patients in this series, and 160 asymptomatic patients 1-4 years postoperatively agreed to have limited upper GI series. Resu lts: Only one of this group had staple-line failure. Failures were see n in four of 19 symptomatic patients with dyspepsia or rapid weight re gain. Putting these two groups together, our staple-line failure rate has been less than 1% using this technique. Conclusion: Whether stapli ng in continuity or dividing the stomach, the two methods appear to be equally effective with comparable morbidity. Patients with staple-lin e failure or gastro-gastric fistulae will ultimately be forced by thei r symptoms of rapid weight regain and/or peptic ulcer disease and refl ux esophagitis to return for follow-up. Asymptomatic patients very rar ely have a connection between upper and lower pouches, and routine fol low-up upper GI series are not indicated.