The growth of the surgical industry and the development of surgical techniques have allowed us to achieve better results for patients. Laparoscopic staplers are a crucial tool in laparoscopic surgery, and despite their proven safety and efficiency, they have been associated with technical and mechanical failures on rare occasions. Adequate knowledge of the surgical instruments is critical to accomplishing optimal results and to adequately treating these rare malfunctions and their consequences. We present a case of a surgical stapler malfunction due to a titanium clip during laparoscopic sleeve gastrectomy. This mechanical failure produced a complication that was adequately resolved, and the patient completely recovered. Our brief communication shows that errors during sleeve gastrectomy can occur, and that precise surgical skills along with a close follow-up are crucial to improve the patient outcome when these rare complications arise.
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Simper SC, Erzinger JM, Smith SC. Comparison of laparoscopic linear staplers in clinical practice. Surg Obes Relat Dis. 2007;3(4):446–50. https://doi.org/10.1016/j.soard.2007.02.008.
Chooi YC, Ding C, Magkos F. The epidemiology of obesity. Metabolism. 2019;92:6–10. https://doi.org/10.1016/j.metabol.2018.09.005.
ElGeidie A, Gadel Hak N, Abdulla T. Stapler’s malfunction during laparoscopic sleeve gastrectomy: an unusual but correctable complication. Surg Obes Relat Dis. 2013;9(1):144–6. https://doi.org/10.1016/j.soard.2012.09.010.
Perinjelil V, Nkansah-Amankra K, Maraqa T, et al. Endo GIA stapler malfunction in a small bowel loop resection. J Surg Case Rep. 2018;2018(10) https://doi.org/10.1093/jscr/rjy281.
Chan D, Bishoff JT, Ratner L, et al. Endovascular gastrointestinal stapler device malfunction during laparoscopic nephrectomy: early recognition and management. J Urol. 2000;164(2):319–21. https://doi.org/10.1016/s0022-5347(05)67349-1.
Hsi RS, Saint-Elie DT, Zimmerman GJ, et al. Mechanisms of hemostatic failure during laparoscopic nephrectomy: review of Food and Drug Administration database. Urology. 2007;70(5):888–92. https://doi.org/10.1016/j.urology.2007.06.1116.
Deng DY, Meng MV, Nguyen HT, et al. Laparoscopic linear cutting stapler failure. Urology. 2002;60(3):415–9. https://doi.org/10.1016/s0090-4295(02)01778-8.
Based on internal test report #R2146–151-0, Powered stapling firing speed DOE analysis and ASA parameters. 2015.
Based on internal test report #R2146–173-0, ASA verification testing with slow speed force limit evaluation. 2015.
Kwazneski D, Six C, Stahlfeld K. The unacknowledged incidence of laparoscopic stapler malfunction. Surg Endosc. 2013;27(1):86–9. https://doi.org/10.1007/s00464-012-2417-y.
Gagner M, Kemmeter P. Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review. Surg Endosc. 2019;34(1):396–407. https://doi.org/10.1007/s00464-019-06782-2.
Wang Z, Dai X, Xie H, et al. The efficacy of staple line reinforcement during laparoscopic sleeve gastrectomy: a meta-analysis of randomized controlled trials. Int J Surg. 2016;25:145–52. https://doi.org/10.1016/j.ijsu.2015.12.007.
Ruiz-Tovar J, Zubiaga L, Muñoz JL, et al. Incidence of postoperative nausea and vomiting after laparoscopic sleeve gastrectomy with staple line reinforcement with oversewing and staple line inversion vs buttressing material: a randomized clinical trial. Int J Surg. 2018;59:75–9. https://doi.org/10.1016/j.ijsu.2018.09.010.
Gundogan E, Kayaalp C, Aktas A, et al. Randomized controlled trial of monopolar cautery versus clips for staple line bleeding control in roux-en-Y gastric bypass. Int J Surg. 2018;58:52–6. https://doi.org/10.1016/j.ijsu.2018.09.007.
Sarker SK, Vincent C. Errors in surgery. Int J Surg. 2005;3(1):75–81. https://doi.org/10.1016/j.ijsu.2005.04.003.
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Molina, G.A., Aguayo, W.G. & Rojas, C.L. Inclusion of a Clip Inside the Cartridge and Failure of the Stapler When Performing a Laparoscopic Sleeve Gastrectomy. OBES SURG (2020). https://doi.org/10.1007/s11695-020-04458-8
- Bariatric surgery
- Staple malfunction
- Laparoscopic sleeve gastrectomy