The Use of Staple-Line Reinforcement During Laparoscopic Gastric Bypass

Divided linear staple-lines are a mainstay of gastrointestinal surgery, and in particular, bariatric surgery. Staple-line failure, although uncommon, can result in significant morbidity and even mortality. Staple-line buttressing has been developed to improve staple-line strength, decrease bleeding and minimize the risk of leak. Many different products are currently available. However, most have not been proven in clinical trials. Bovine pericardial strips (BPS) are a buttressing material that fits onto the stapler device and gets "stapled" onto the tissue when the device is fired. The strips add thickness and potentially strength to the staple-line. Animal research has shown that staple-lines incorporated with BPS had higher burst pressures than those without. Human experience has suggested that BPS decreased the risk of acute staple-line failures in laparoscopic Roux-en-Y gastric bypass surgery. This report reviews the clinical and research experience with this product.