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15 years of the GORE®SEAMGUARD®

Celebrating 15 years of the GORE®SEAMGUARD® SLR

How the product allows the surgeon to perform with greater confidence and why the product improves patient outcomes despite remaining unchanged for 15 years

In June 2003, WL Gore & Associates (Gore) introduced the GORE®SEAMGUARD® Bioabsorbable Staple Line Reinforcement, an innovative, bioabsorbable material designed for reinforcing surgical staple lines in bariatric and metabolic surgery. Since its launch, the product has been implanted in more than three million procedures and has been featured in 60+ peer reviewed clinical publications. Bariatric News talked to Dr Jaime Ponce, past-President of the ASMBS and Medical Director of Bariatric Surgery at CHI Memorial Hospital, Chattanooga, TN, about his 15-year experience using GORE®SEAMGUARD® Bioabsorbable Staple Line Reinforcement Material, how the product allows the surgeon to perform with greater confidence and why the product improves patient outcomes despite remaining unchanged for 15 years.

Jaime Ponce

“I first heard about SEAMGUARD just after I started performing sleeve gastrectomies in 2007, when one of my colleagues, Dr Ninh Nguyen, presented data on the decreased bleeding rate from stapling when using SEAMGUARD,” Dr Ponce recalled. “Afterwards, we discussed the product in a meeting and I was motivated to try it. I used the product for the first time shortly after and my initial thoughts were that it was very effective at stopping the intraoperative oozing or annoying bleeding from staple line, as well as allowing me to see good staple formation and a dry field. After doing more research, I found that the SEAMGUARD was supported by literature written by my bariatric peers from around the world, and this increased my trust in the product.”

Learning curve

He said that SEAMGUARD is easy-to-use and can be loaded quickly and easily onto stapler jaws and stays in place during insertion through trocars and during tissue manipulation. As with all products, Dr Ponce acknowledged that there is a learning although after a few cases using SEAMGUARD the application becomes ‘routine’. He advised surgeons who are using SEAMGUARD to remember to ‘pull the strings’ before firing the stapler.

“SEAMGUARD has a nice distribution of force, this reinforcement increases the strength of the resection line by evenly distributing the staple pressure exerted on the tissue over a wider surface of area, so not only does it offer better staple formation but better haemostasis too. SEAMGUARD is only .4mm and therefore allows a wide range of tissue thicknesses to be stapled.” Dr Ponce explained. “SEAMGUARD is a synthetic copolymer - polyglycolic acid:trimethylene carbonate (67% PGA:33% TMC), which features an open, highly interconnected pore structure that facilitates cell infiltration and ingrowth, tissue generation and healing. Crucially, this means the degradation process results in minimal, to no, visible inflammation.”

According to Dr Ponce, another important consideration is the value of the buttressing material to secure the staple line during sleeves gastrectomy compared with other technique like oversewing or the use of titanium clip - oversewing increases the procedure time and titanium clips can be potentially dangerous during revision surgery.

Confidence

“I believe oversawing always has the potential for tension and pull through injuries to the stomach wall and titanium clips can create areas of tissue ischaemia around staple line”, added Dr Ponce. “Over the years, SEAMGUARD proved invaluable as in many cases it has saved valuable operative time as there is no longer a need to deal with stapler line bleeding or oozing. I now have complete confidence regarding staple line formation and I am able to use the SEAMGUARD for omentopexy to stabilise the sleeve pouch orientation, and it has potentially saved me from adding protective burst pressure and thereby avoiding another serious complication.”

“That SEAMGUARD has remained unchanged for 15 years - a considerable achievement in today’s everchanging medical devices market – is a testament to the product’s safety and efficacy,” concluded Dr Ponce. “It has been shown in the literature to reduce the of risk of complications leaks and bleeding, thereby avoiding increased costs due to longer hospital stays. It is absorbable, less reactive, easy to use and, most importantly, very effective!”

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