Laparoscopic Vertical Sleeve Gastrectomy: A Technological Alternative for Imbrication

Background: Laparoscopic vertical sleeve gastrectomy is one of the most commonly used bariatric procedures. One of the dreaded complications associated with this procedure is a leak occurring at the staple line. Staple line leaks occur in ~2.8% of cases, and can be because of a variety of reasons such as technique, poor vascularization, and inflammation. Numerous modalities are available to reinforce the staple line in an attempt to prevent postoperative staple line leaks. One technique that may decrease complications and provide reinforcement includes imbrication of the vertical sleeve gastrectomy staple line. Imbrication has been associated with providing additional strength to the staple line. Although this may be technically challenging by free hand intracoporeal suturing, we employ the Endo360™ device. This device allows the surgeon to perform intracorporeal suturing similar to the Endostitch™. Major advantages include a sharp and curved needle on an instrument in which articulation is possible. This extra step may help to decrease complications associated with a vertical sleeve gastrectomy. Materials and Methods: Endo360 instrument with nonabsorbable 2-0 suture is used for staple line imbrication. Conclusion: Intracorporeal suturing by free hand can be technically challenging. The Endo360 device allows the surgeon to imbricate the vertical sleeve gastrectomy staple line and possibly decrease complications such as leaks. Our video demonstrates the technique we employ while using this instrument. No competing financial interests exist. Runtime of video: 5 mins 52 secs