Laboratory evaluation of four techniques of stapled gastroplasty

Four techniques of stapled gastroplasty including unreinforced horizontal gastroplasty (UHG), suture-reinforced horizontal gastroplasty (SHG), Marlex banded horizontal gastroplasty (HBG), and Marlex banded vertical gastroplasty (VBG) were studied in mongrel dogs. Twelve dogs survived operations by each technique and were killed in groups of four at 3, 6, and 12 weeks after operation. Five deaths caused by leaks occurred after UHG (one), SHG (one), and HBG (three). Disruption of the staple line occurred after UHG (four), HBG (one), and VBG (three). Mean stomal diameter at death for UHG (2.1 cm) and SHG (1.5 cm) was substantially greater than the initial diameter of 0.9 cm. Mean stomal diameter at death for HBG (1.4 cm) and VBG (1.3 cm) was only slightly larger than the initial diameter of 1.2 cm. There was no correlation between the degree of stomal dilatation and time of death. There was no evidence of erosion of Marlex through the gastric wall in dogs that survived to the time of death. These data suggest that stomal reinforcement with Marlex mesh effectively limits dilatation and is safe when sutured to itself rather than to the stomach. Reinforcement of the stapled partition with sutures may be necessary to eliminate staple-line disruption.