Background: Controversy continues concerning the best method of isolating upper and lower gastric pouches in Roux-Y gastric bypass. This paper reports a technique used from August 1991 through May 1996, in which there was a double application of the TA-90 B Four-Row AutoSuture® 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. Results: Only one of this group had staple-line failure. Failures were seen in four of 19 symptomatic patients with dyspepsia or rapid weight regain. Putting these two groups together, our staple-line failure rate has been less than 1% using this technique. Conclusion: Whether stapling in continuity or dividing the stomach, the two methods appear to be equally effective with comparable morbidity. Patients with staple-line failure or gastro-gastric fistulae will ultimately be forced by their symptoms of rapid weight regain and/or peptic ulcer disease and reflux esophagitis to return for follow-up. Asymptomatic patients very rarely have a connection between upper and lower pouches, and routine follow-up upper GI series are not indicated.
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Jones, K.B., Homza, W., Peavy, P.W. et al. Double Application of TA-90 B Four-Row AutoSuture® Stapling Instrument: A Safe, Effective Method of Staple-Line Production Indicated by Follow-up GI Series. OBES SURG 6, 494–499 (1996). https://doi.org/10.1381/096089296765556395
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DOI: https://doi.org/10.1381/096089296765556395