Evaluation of Alternate Laparoscopic Stapling Device for Bariatric Surgery

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Bariatric

Evaluation of Alternate Laparoscopic Stapling Device for Bariatric Surgery

Gregory F. Walton, MD; Toby D. Broussard, MD
Edmond, OK, USA

Surgical Laparoscopy, Endoscopy and Percutaneous Techniques (SLEPT), October 2023; 33(5):505-510

1,848
Total patients
814
AEON cohort
1,034
Endo GIA Tri-Staple cohort
Key finding: Largest published AEON dataset: 1,848 bariatric patients. Procedures included SG (n=1,359, 73.5%), RYGB (n=425, 23.0%), and SADI-S (n=64, 3.5%). Both devices were safe and effective with low complication rates and comparable clinical performance in sleeve gastrectomy and SADI-S. Statistically significant differences in complication rates were observed in Roux-en-Y gastric bypass favouring the AEON Endoscopic surgical stapler, including fewer overall complications, fewer transfusions and fewer reoperations for staple line bleeding.

Abstract

Background:
As laparoscopic bariatric surgical techniques have matured, the incidence of complications has decreased over time. Surgical stapling devices are commonly used for resection and anastomosis of gastric tissue during bariatric surgery. The purpose of this study is to assess and compare complication rates and clinical outcomes between patient cohorts using 2 different approved stapling devices.

Materials and Methods:
Clinical outcomes were retrospectively compared for patients undergoing bariatric surgery between April 2019 and December 2020 using laparoscopic surgical stapling device A (LSSD-A) against outcomes between January 2017 and September 2018 using laparoscopic surgical stapling device B (LSSD-B). Tradenames for LSSD-A and LSSD-B were AEON Endostapler and Endo GIA with Tri-Staple Technology, respectively.

Results:
In all, 814 patients underwent laparoscopic bariatric operation using LSSD-A and 1034 using LSSD-B. Laparoscopic surgery included sleeve gastrectomy (n=1359, 73.5%), Roux-en-Y gastric bypass (RYGB) (n=425, 23.0%), and single anastomosis duodenoileostomy with gastric sleeve (n=64, 3.5%). Stapler-related complications were evenly distributed over the 20.9-month LSSD-B study period. No stapler-related complications were seen in the last 13 months of the LSSD-A study period, during which time 428 (52.5%) laparoscopic bariatric operations were performed. One staple line leak was observed, occurring in the LSSD-B group. Patients undergoing laparoscopic RYGB with LSSD-A had fewer overall complications, fewer transfusions, and fewer reoperations for staple line bleeding.

Conclusions:
Both LSSD-A and LSSD-B were safe and effective in the performance of laparoscopic bariatric operations with low complication rates and comparable clinical performance in sleeve gastrectomy and single anastomosis duodenoileostomy with gastric sleeve. Statistically significant differences in complication rates were observed in RYGB favoring LSSD-A.

*Abstract text reproduced from the original publication with attribution to the authors and publisher. All rights remain with the respective copyright holders. Reproduced here for informational and educational purposes in accordance with applicable open-access licensing or fair use principles. For the definitive version, refer to the original publication via the link provided.

Clinical Relevance: The scale of this dataset (1,848 patients) provides a level of statistical confidence that smaller trials cannot match. The finding that AEON showed fewer complications specifically in RYGB is notable because gastric bypass involves more complex staple line anatomy than sleeve gastrectomy. For bariatric surgeons and value analysis committees evaluating stapler options, this offers real-world outcome evidence across a high-volume practice performing multiple procedure types.
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