Staple Line

Double staple line or triple?  Does it matter as far as preventing leaks? 
Some docs over sew the staple line others do not?  Does over sewing the staples prevent more leaks?

Not sure of the answer, but just wanted to give you encouragement. At some point, you have to pick a surgeon you trust, and them do just that, trust him/her to make the best decisions for your care. You've done tons of research, you're looking at safer surgeons, you'll be fine. I know it's scary leaving three country and self paying, but that's why you pick the best surgeon you can, and then follow their pre and post instructions. It will be all good.

Thanks for the encouragement!  :-)   I think I'm leaning towards Dr. Aceves or having surgery locally.  Found out locally they don't have as much experience never had leaks but they don't have many surgeries to go by with the stats.    It would be easier to do it local even if it cost more but not sure if they are as experienced with the VSG as I'd want them to be.    

That was my experience exactly. Cost wasn't my only factor, so I meet with the local surgical groups. We have two bariatric groups, representing 4 surgeons, and no surgeon had over 30 sleeves. I didn't want to be someone's 30th sleeve, or even their 100th. Let me be their several hundredth. if a local surgeon had the complication free numbers as aceves, I would have stayed local. but they didn't, not by a long shot. And, my local bariatric group was fine with treating me if complications arose after I got home, which, knock on wood, they haven't.

Yeah.  Well I met 3 surgeons local. 

doc #1 1 did 9 VSG
doc #2 1 did a little over 200 VSG
doc #3 1 did almost 300 VSG


Well I'm definitely not going to be #10 for doctor number 1.  LOL

But maybe 200 or 300 is enough I'm not sure.  None of the doctors had leaks.  Although the third doctor that did close to 300 had 5 leaks between doing the DS and R n Y but none with the sleeve.    So maybe I should go with Doctor number #2 if I go local. 

What I would strongly recommend is that you ask your doctor for HIS stats on leaks and other problems.  There is the national average and each doctor has their own stats. 

The machine does the staple line and it does double staples AND cuts the tissue between the staples.  So your remaining stomach is stapled closed and the part of the stomach that's being removed is also stapled closed, because you don't want stomach stuff leaking into your abdominal cavity while it's being pulled out.

Whether your doc oversews or glues or whatever is up to them.  Question them about it and, as Elina said, get THEIR statistics on leaks and complications.

 
This is where the "art" and "science comes in......

Shape ......Very important.....

Skills.....Staples are straight.... proper staple line shape is curved.......when it's done it should lay really flat with no tweaks, kinks or twisting..... not easy....

frisco

Im not sure double or triple, maybe double. I don't think it matters as far as leaks go. Some literature Ive read is if the surgeon does not change out the staples to smaller cm ones when up at the gastro esophogeal area (fundus/cardia) where most leaks occur, (that space is tuff very compact , spleen right under, harder to get a clean staple line)... increases incidence of leaks happening as staples are too thick for the tissue to get a tight seal. Not as much tissue thickness as the muscular antrum (pylorus) where they start resecting the stomach. A surgeon will reload 4-6 times. Oversewing is usually at the junctures when surgeon .has created a break when reloading the stapler to prevent bleeds and leaks. A continuous or running oversewn line across the majority of resected stomach is rarely done. You would have to discuss most of your questions with the surgeon you choose.

Some info on my Bougies in VSG blog may help.
http://www.obesityhelp.com/member/carmelita/blog/tag/bougie+in+vsg/

Shows some leak testing. You can pass a leak test in the OR and post op while in the hospital...and still have a leak. The swelling and inflammation from surgery, may "clog" a tiny leak/hole...once that swelling and inflammation subsides in ~ a month...into the ER ya go! The leak was there ALREADY! Leaks do not randomly happen. Only sustained from SURGERY/CUTTING!!
Can take a look at my LEAKS and STRICTURES blog as well.
http://www.obesityhelp.com/member/carmelita/blog/tag/vsg+lea ks+and+strictures/

You cannot eat ANY food stuff and cause a leak to happen!
It just gets my goat that peeps here still tell newly post oppers that... you don't want to eat that ..you'll get a leak.....crazy ****! Guilt trips won't reinforce a staple line!

Definately talk to the surgeon you choose.
How many VSGs has s/he done 75 and over is what ya wanna look for.
Ask about leak rate (not that you'll get the truth)...look for ~2% or less

edited: 2.4% not 2.2% ...is Dec. 2011 leak rate in the US.
higher than reported in 2009 at 1.7% ...as many more VSGs are done since..stands to reason!

If I were to sustain a leak, how do you repair them...currently JP drains seem most effective. Hopefully caught early....s/s of LEAK on my blog ^^...71 days is average leak repair rate.

Most important gauge in my opinion is ask....HOW DOES ONE GET A LEAK?
if surgeon says.....eating the wrong foods too soon after surgery.....RUN...s/he IS A LIAR!!
if surgeon says...not getting a clean staple line, from surgery, a risk of surgery, staple gun misfiring THAT'S YOUR WO/MAN

Helps ya ? no? lololol

That is helpful information.  Thank you.
However the info I got  about cause a leak by not following the post op diet was not from a sugureon.  I think I read it some where online but honestly with all the reasearch I've done I can't say where.  But what it explain if you starting eating and getting out of the liquid phase too soon because you are still healing you can cause an infection which may result to a leak. 
Rate for leaks in Mexico is less than 1% I think I'm going there afterall since the US is over 2%.  LOL!!