Significantly reduced post-LSG GERD rates with the Titan SGS Stapler vs. multi-fire staplers

A retrospective analysis of clinical data associating the use of the Titan SGS Stapler with reduced rates of post-operative GERD following robotic-assisted laparoscopic sleeve gastrectomy (LSG) compared with traditional multi-fire surgical staplers. The retrospective study comprised 257 patients who underwent robot-assisted sleeve gastrectomy using the Titan SGS Stapler or multiple fires of a traditional linear stapler between 2016 and 2023. All procedures included in the study were performed by a single surgeon.

While sleeve gastrectomy is the most common weight-loss surgery and is associated with a low rate of adverse events during and following surgery, a 2024 review of 109 studies found “a persistent concern for worsening and de novo GERD” after sleeve gastrectomy. Pouch shapes based on anatomical landmarks have previously been shown to help reduce the incidence of GERD but highly variable surgical techniques and multiple stapler fires yield inconsistent pouch anatomy. Consequently, one study found that bariatric surgeons have been able to achieve the ideal tubular sleeve anatomy less than 40% of the time, resulting in inconsistent patient outcomes, including GERD and nausea.

The publication reports retrospective observational data that at one-year post-procedure, significantly fewer patients in the Titan SGS Stapler cohort reported having GERD (7.1%) compared with the multi-fire cohort (26.4%) (p=0.002) and significantly fewer patients in the Titan SGS Stapler cohort developed de novo GERD (1.8%) compared with the multi-fire cohort (10.9%) (p=0.005). Additionally, more patients in the Titan SGS Stapler cohort who had GERD prior to the procedure saw resolution of this condition, compared to the multi-fire cohort (25% vs. 10.9%, p=0.005). Notably, the improvements in GERD outcomes linked to the Titan SGS Stapler were achieved without a significant difference in weight loss at one year between the two cohorts (multiple-fire: 22.4% ± 0.7%, single-fire: 22.0% ± 1.7%, p=0.8).

“Improving clinical outcomes for patients, including the development of post-operative GERD, may be important for wider adoption of bariatric surgery, which remains the most effective and durable obesity treatment,” said Dr Forrest Ringold, an expert in bariatric and robotic surgery at the Surgical Association of Mobile and senior researcher on the publication. “This study shows that GERD was less common in LSG procedures that used the Titan SGS Stapler. I believe this is because the 23cm single-fire Titan SGS Stapler is intentionally designed to enable more consistent and symmetrical sleeve anatomy and to provide reproducible pouch anatomies from patient to patient. This study adds to a growing body of evidence supporting the potentially enhanced perioperative benefits linked to the Titan SGS Stapler in sleeve gastrectomy.”

The Titan SGS Stapler is the first and only single-fire, surgical stapler designed and indicated specifically for sleeve gastrectomy pouch creation. As the only stapler to provide a 23cm staple line, the industry’s longest continuous staple cutline, the Titan SGS Stapler is designed to provide an ideal tubular surgical sleeve anatomy that is a consistent shape, free of kinks, twists, or spirals, improving the potential to resolve GERD and nausea.

“The Titan SGS Stapler was developed to enable more consistent and symmetrical sleeve anatomy because we believe that sleeve shape significantly contributes to sleeve gastrectomy efficacy and safety outcomes,” said James Ferguson, President and General Manager, Surgical, at Teleflex. “The study’s authors hypothesise that the improved GERD outcomes reported in the Titan SGS Stapler cohort may be because the 23cm single-fire continuous staple line without overlapping staple firings ‘results in less kinking along the sleeve staple line, which prevents inadvertent narrowing’. This suggests that consistent sleeve shape may play a role in reducing GERD.”

In previous retrospective studies, the Titan SGS Stapler has been associated with significantly reduced operative times,8 less post-op nausea and vomiting and the potential for increased operational efficiencies and significant reductions in LOS and readmissions.

The findings were reported in the paper, ‘Does Stapling Platform Influence Robotic Sleeve Gastrectomy Postoperative Outcomes?’, has been published online in Obesity Surgery. To access this paper, please click here