Self-Locking Sliding Knots in Laparoscopic Bariatric Sutures
Staple suture line reinforcement can be made with different materials. A continuous inverting
suture of the entire suture-line, including the omentum, is the best.
We use a 12 mm intragastric tube as a guide, and de vascularize all the major curvature
vessels, passing from the esophageal ?gastric junction to distal to the pylorus at the duodenal
junction. We start the gastrectomy from the pylorus with sequential staplers up to the esophago-gastric
junction and routinely try to prevent bleeding and leakage at the staple line with suture
reinforcement that includes omentum and the posterior and anterior gastric walls along the
entire length of the gastric staple line. The goal of using the already divided omentum along
with the suture line is to prevent rotation of the gastric tube.