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15 years of the GORE SEAMGUARD

Celebrating 15 years of the GORE SEAMGUARD SLR

the importance of mechanical reinforcement of the staple line, how the material reduces perioperative morbidity and why it is particularly useful for revisions

In our second in a series of interviews, Bariatric News talked to Mr Marco Adamo, a consultant in upper gastrointestinal, bariatric and minimally invasive surgery at University College Hospital London, UK, about his 15-year experience using GORE®SEAMGUARD® Bioabsorbable Staple Line Reinforcement, the importance of mechanical reinforcement of the staple line, how the material reduces perioperative morbidity and why it is particularly useful for revisions.

WL Gore & Associates (Gore) introduced the GORE®SEAMGUARD® Bioabsorbable Staple Line Reinforcement Material, an innovative, bioabsorbable membrane designed for reinforcing surgical staple lines in bariatric and metabolic surgery in June 2003. Since its launch, the product has been implanted in more than three million procedures and has been featured in 60+ peer reviewed clinical publications.

Marco Adamo

“My first experience with GORE®SEAMGUARD® was in 2004 when I was working in Leeds as bariatric fellow with Professor McMahon and Mr Dexter, who were both very early adopters of laparoscopic sleeve gastrectomy (LSG) performing their first procedure in late 2000,” began Mr Adamo. “I first heard about GORE®SEAMGUARD® in 2004 and realised that this product was something I required. At the time, there was a real need for a staple line reinforcement in LSG in due to the high complication rates - especially leaks - observed. We believed that current two-line staplers were not strong enough to withstand the intraluminal pressures generated by LSG, hence the need for a mechanical reinforcement such as GORE®SEAMGUARD®.”

He recalls that the first time he used the product he was surprised by the product as it was softer, thinner and more elastic than competitors, and its design enhanced its mechanical reinforcement of the staple line. During the last 15 years he added that his LSG technique has obviously evolved however, the use of GORE®SEAMGUARD® has always been a main part of his operation. In Mr Adamo’s opinion the early routine adoption of GORE®SEAMGUARD® helped in reducing the perioperative morbidity, especially in a time when stapling devices were less refined than they are today.

“The use of GORE®SEAMGUARD® allows a mechanical reinforcement of the staple line and more even distribution of the pressure applied from the titanium staples,” explained Mr Adamo. “My experience with other buttressing materials is very limited and resulted in very poor outcomes.

The mechanical effect is essential in reducing post-operative bleeding. The increased strength and burst pressure of GORE®SEAMGUARD® reinforced staple line also protects from staple line leaks.”

Revision surgery

In his experience GORE®SEAMGUARD® has proved particularly valuable for revision surgery due to deterioration of the quality of the gastric tissue because of scarring and fibrosis. In such circumstances, there is a potential for titanium staples to cut through the scar tissue because the lack of elasticity. However, he explained that having a large surface area to share the pressure applied to the stomach by each one of the staples is, in his opinion, invaluable.

“The changing or evolving of medical devices is an expensive task which is usually undertaken if there are performance concerns regarding the device or for marketing purposes. With GORE®SEAMGUARD® this is not the case – the quality and performance of GORE®SEAMGUARD® has remained paramount – this is illustrated in the literature and, in my experience, the excellence of GORE®SEAMGUARD® is even recognised by many non-users.”

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