Dr Jayasshree S Todkkar
Director, Jt Obesity Solutions, International Centre of Excellence for Obesity and Laparoscopic Surgery,
Dr L H Hiranandani Hospital

Advanced Staples Make Gastrointestinal Surgeries Safe, Effective, And User-Friendly

Obesity is the chronic multifactorial disease associated with more than 100 aggressive and progressive serious medical diseases like hypertension, diabetes, hypothyroidism etc. American Medical Association has declared obesity itself as a serious medical disease back in 2004. In the etiopathology of the disease, three factors are important, namely, genetic, environmental/behavioral, and metabolic system of individual. It is important to know that obesity diagnosed at any stage of the disease is worth treatment because it is a progressive disease. Apart from traditional treatments like changes in dietary regimes and physical activity, some medications, and metabolic restoration using gastrointestinal anatomical modifications plays an important role in treatment of the disease. Bariatric surgery is the scientifically proven standard of care to achieve successful and sustainable weight loss over a long period of time in the patients with obesity and/or metabolic disorders.

Various types of bariatric surgeries can be considered and appropriate surgery can be chosen in the given individual depending on the medical risks, severity of metabolic syndrome, and expectation of weight loss and resolution of co-morbidities. More than 100 surgical and medical diseases are linked with or get worsened with obesity. Obesity hampers health via two mechanisms i.e. chemical/metabolic symptoms and mechanical/pressure symptoms. The metabolic disorders show a very significant resolution/reversal/improvement after bariatric surgery even before the weight loss is apparent. Bariatric science today knows that bariatric surgeries work via two mechanisms i.e. weight loss dependent and weight loss independent. Because of these new revelations about the clinico-pathological orientation of the disease after bariatric surgery, the new treatments are emerging to treat metabolic disorders. The bariatric surgeries work via multiple mechanisms namely, gut hormone axis, adipoinsular axis, and gut brain axis.

Various bariatric surgeries work via different mechanisms. Recently, the extended application of bariatric surgery is advised to treat severe metabolic syndrome in the less obese individuals also. That is why these sciences are now also known as meta bariatric surgeries. Since 2003 till now, we have operated more than 6500 patients across the globe; a lot of advances have taken place in the technologies which make these operations safe and effective. For example, the linear staplers which were used for the bowel cutting and anastomosis have travelled from straight nonadjustable to different sizes and articulating. These different sizes of the staple length help us approximate the tissue in the proper way. Also the articulating mechanism which is added in the stapler helps us achieve the precise size of the gastric tube and also of gastric anastomosis. There are some tristaple technologies which are in the market recently; the staple size of these staple decreases progressively toward middle so the outer staples are more thick and inner ones thin. This also helps in more precise approximation of tissue.

During surgery, the surgeons tend to stand in one position but the staples need to be fired in various quadrants of the abdomen. In such situations, ergonomics wise it becomes tedious to staple fire manually every time with precision of angle and continuum of pressure. In this regard, the battery operated staplers gives a very good advantage by providing uniform consistent pressure and precision in the formation of the staple line and anastomosis. All these factors eventually add up to the safety and outcome so the operation remains clean and least contaminated.

During our surgical career, that is, since last 25 years, we have being using the evolving stapling technique, particularly in difficult situations like emergency and trauma; very friable tissue; onco surgery; laparoscopic surgeries/minimal access surgeries; obese patient; and difficulty axis area. The use of staples significantly adds to the safety and effectiveness of the operation and also reduces time of surgery and anesthesia. Even in robotic surgery, staples are a very efficient assistant for a long duration operation. Over last 25 years we have performed more than 50 thousand general, laparoscopic, and bariatric surgeries. The technological advances of the equipment, for example surgical stapler, can reduce fatigue of surgeon, improve stamina, and efficiency and length of surgical life of a surgeon.

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