Background: Sleeve gastrectomy has become the most common procedure to treat patients with morbid obesity. Hemostasis on the staple line is essential to prevent bleeding complication. Electrocautery on the staple line must be applied carefully and precisely. The electrocautery effect on postoperative leakage is still controversial. The present study was designed to demonstrate histological changes on the extracted specimens after applying electrocautery that may help addressing this question.

Materials and Methods: After sleeve gastrectomy was performed, the divided part of the stomach was immediately used as a surgical specimen. Different spots on the staple line of each specimen were electrocauterized by a monopolar hook for different length of time such as one second, two seconds, three seconds, four seconds, and five seconds. A systematic study was conducted. Each electrocauterized spot on the staple line was studied in three dimensions, two lateral sides, two longitudinal sides, and thermal injury in depth to evaluate tissue injury on the staple line.

Results: Eighty-five pieces of tissue, five on each of seventeen slides, were studied macroscopically and microscopically. Macroscopically, the tissue injury did not exceed the staple line. Microscopically, submucosa, and intramuscular hemorrhage and cellular swelling were found in both electrocauterized and non-electrocauterized areas. Nevertheless, neither cell death nor structural change was found.

Conclusion: Precisely and carefully performed electrocautery on sleeve gastrectomy staple line is effective for hemostasis and has been proven to be safe in the present histological study.

Keywords: Electrocautery, Sleeve gastrectomy, Staple line