Doctor Edgar Campos from Mexicali Bariatric Center in Mexico answers questions about the stapling process in bariatric surgery enabling patients to be informed about the complete process of gastric surgery.
One of the most frequently asked questions that we get is regarding staples, a very important element in weight loss surgery. The first thing you need to know is that they are disposable devices. That means that we do not reuse nor sterilize any used staples. They are disposable and we use new staples for each patient. That is because like in regular office staples, when the staple is fired out, it closes upon application. The huge difference between office staples and surgical staples is that these are made out of titanium, which is less reactive on the body.
Another question we are asked is, are the staples going to stay in my body forever?
The strength of the stomach during surgery debilitates due to the scar tissue. The staples are meant to hold everything in place until the stomach creates scarring tissue around the staple line and protects and seals it but, because they are very small there will be scar tissue growing around the staple line and we can’t remove them after the surgery. That means that the staples will stay in your body. You need not to worry because they don’t set off any metal detectors or make you beep at the airport you have very small non-reactive titanium staples.
The staple cartridge can be of 60 staples or the smaller cartridge of 45. The number refers to the length of the disposable staple cartridge. Each cartridge comes with 3 lines of staples on each side, that means that there are 3 rows of staples which gives the patient more protection and reduces the possibility of leakage. The staple cartridge has a blade in the middle, which will cut, and then 3 more rows of staples are applied to secure the tissue that will be removed, which needs to be stapled as well.
What kind of staples are used in Mexicali Bariatric Center?
The staples we use here in Mexicali Bariatric Center that are used in gastric sleeve, bypass and duodenal switch surgeries are different types of staple cartridges because we have different kinds of tissue; for example, we have a black cartridge from the Johnson & Johnson family which is the Ethicon brand.The black cartridge is a thicker cartridge for thicker tissue, like the lower part of the stomach which has more girth than the rest of the stomach. These cartridges can staple around 4.4mm of tissue, although it sounds a like a small amount of tissue, we staple 2 sides of the stomach which creates a sandwich of the tissue in the middle and then we’ll staple that.
There is something very important that we need to do during stapling which is locating the tissue that we’re stapling and then pull a little and squeeze it so the tissue stays together without moving or flowing around. The second thing we need to consider is weight, that’s quite important because if we just close the stapler and fire it up, there is not enough time to move the water and blood inside the tissue to the sides and when we staple that water will increase the size of the tissue. What we do is hold that part and wait for about a minute so it drains and reduces its size and then we fire it up and remove the stapler. We have videos showing how we do this and how the surgery is being done.
The second kind of staple or cartridge that we use is the green one that has a thickness of 4.1 mm and normally is the one that we use for the antrum which is the lower part of the stomach. On a gastric sleeve surgery here in Mexico we normally begin with a black cartridge and then we continue with the green and then follow with the blue one which is the 3.5mm staple and the one with less thickness than the others and the most commonly used for the rest of the stomach. Finally, we use the white staple that has a 2.5mm girth and it normally used for the intestines or anastomosis.
It is quite important that we use the correct staple for each type of tissue because if we do not we increase the risk of leakage or bleeding, if we use a very thick cartridge on a thin tissue, for example, we can have bleeding and can lead to a complication.
It is very important as well to use brand name staples. We only use Ethicon cartridges which are FDA approved. Ethicon is a Johnson and Johnson brand. We are very strict with the standards and quality of the materials we use during all surgeries.
How can a patient know what kind of staples the surgeon is using?
The patient can ask the surgeon to show him or her the brand that is being used. Whether it is Johnson & Johnson or any other brand, it comes with a serial number and a code that can be scanned, that gives reassurance that the surgeon is using a brand named staple.
During revision surgeries here at Mexicali Bariatric Center we have seen patients that have only 2 or 3 parts of the stomach stapled, this is because the amount and type of staples that the surgeon uses elevates or diminishes the cost of the surgery, so in order to lower the cost of the surgery, the surgeon minimizes the use of staples and puts the patient at risk and reduces their chances of having good long term results.
Should patients be aware of counterfeit staples?
What we advise, is to ask your surgeon what type of staples he or she will be using. Be aware that any counterfeit staples could be a problem. We have known of doctors who in order to make profit they risk the patient's well being by purchasing counterfeit Chinese staples that are not 100% titanium, causing negative reactions to the tissue and could lead to serious complications, So, we strongly suggest to ask your doctor what kind of products are being used on your surgery.
