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Hanan M Alghamdi 10.5005/jp-journals-10033-1284
CASE REPORT

Novel Technique in Laparoscopic Staple-line Reinforcement

Hanan M Alghamdi

ABSTRACT DESCRIPTION OF THE TECHNIQUE
Bleeding prevention and control can be very challenging in In laparoscopic surgery (mostly sleeve gastrectomy), the
laparoscopic surgery. The author describes a new and less
expensive technique to lower the incidence of staple-line staple line is reinforced with hemostatic material using
bleeding in laparoscopic surgery. one piece of SURGICEL SNoW ® (4 × 4 inches) or large
SURGICEL Original absorbable Hemostat folded once,
®
Keywords: Laparoscopic, Laparoscopic hemostasis, Lapa- and cut in the exact size of the stapler cartridges (usually
roscopic staple line, Laparoscopic staple-line reinforcement.
one piece cut for five to six loads of cartridges). After
How to cite this article: Alghamdi HM. Novel Technique in loading the cartridges (any cartridge thickness depending
Laparoscopic Staple-line Reinforcement. World J Lap Surg on the indication) onto the stapler handle (Echelon ® or
2016;9(2):104-106.
Endo GIA™), the piece of hemostatic material is tied twice
®
Source of support: Nil with 3-0 or 2-0 absorbable suture (VICRYL Ethicon). The
tie could be one or two loops (Fig. 1). The distal tie has
Conflict of interest: None
to be at least 10 mm before the last staple to guarantee
complete cut; likewise, the proximal tie has to be applied
INTRODUCTION 10 mm after the blade site to allow free initial movement
of the blade (Fig. 2). The stapler with enforced hemostatic
Minimally invasive surgery offers a variety of advantages material is applied to the tissue (stomach) or vascular
over the open approach; these include, but are not limited pedicle, e.g. splenic pedicle, then after waiting for 15 to
to, less postoperative pain, faster physiological function,
shorter length of stay and better cosmoses. However, a 20 seconds as the stapler manufacturer recommendations,
continuous challenge for the laparoscopic surgeon and the stapler is fired and removed. The two crossing threads
the most common cause of conversion to open surgery are cut with a scissor (Fig. 3). If it is sleeve gastrectomy,
is to keep the surgical field almost free of bleeding. the whole process is repeated until the last load. To save
Moreover, blood absorbs light causing darkness and time, a trained nurse or an assistant surgeon can do the
suboptimal intra-abdominal working field, and it is hemostatic material application.
difficult to control bleeding by laparoscopic means
as compared with the open technique. Subsequently, DISCUSSION
massive bleeding allows no opportunity for the efficient Bleeding has been reported to be a major complication of
application of the open approach maneuver, as an laparoscopic surgery. This has become more worrisome
example direct compression or tying. A number of
commercial buttressing materials have been described to
give more hemostasis to the staple line whether it is used
for bowel resection, organ resection or vascular control.
The buttressing material also had questionable leak
prevention advantage. Unfortunately, these materials
are expensive, with limited shelf life and the need for
training to apply them. 1

Assistant Professor and Surgeon
Department of Surgery, King Fahad Hospital, University of
Dammam, Dammam, Saudi Arabia
Corresponding Author: Hanan M Alghamdi, Assistant
Professor and Surgeon, Department of Surgery, King
Fahad Hospital, University of Dammam, Dammam, Saudi
Arabia, Phone: 00966502828333, e-mail: hmalghamdi@uod. ® ® ®
edu.sa Fig. 1: Powered-Echelon and fixing the SURGICEL SNoW
®
to it by 2-0 VICRYL Ethicon suture
104