Stapler Scapegoated in Death

Stapler cited in gastric bypass death

DURING THE course of a standard laparoscopic gastric bypass surgery, a widely utilized staple gun apparently malfunctioned, leading to a significant complication, Brigham and Women’s Chief Medical Officer Andy Whittemore said in statement released by the hospital. The relationship of that complication and her ultimate death remains at present unclear.
(the patient), a 37-year-old woman from Lawrence, Massachusetts, died two days after the Oct. 21 surgery, which involved reducing the size of her stomach.
While the cause of death has not been established, the hospital is working with the family to fully understand all issues bearing on her outcome, the hospital said in the statement.

Hmmm. The article doesn’t say when the ‘stapler malfunction’ was recognized, but it seems odd they’re pushing it so hard as the cause of the patients’ death.

I’m not a surgeon, and I’m fortunate in that there are very few super-fancy medical devices used to directly treat my patients, so I don’t have to worry a lot about how to recover from gadget malfunctions.

As I recall from my surgical intern days, a GIA (GastroIntestinal Anastomosis) stapler is an alternative to a hand-sewn anastomosis; the stapler does it quickly, with a nice, pretty row of staples, and it’s quick; a hand-sewn connection requires more time. I’ll let surgeons educate us as to which has the higher complication rate (Cut-to-Cure, that’s your bait). (Aside: I know one surgeon whose practice is largely gastric bypasses, and even laparoscopically does hand-sewn anastamoses. Quickly.)

Seems that this hospital is working hard to pin the blame on the hardware, but the surgeon is ultimately responsible. Captain of the ship doctrine, and all that. The only time that there should be some shared blame is when the equipment malfunction cannot be discerned until later.

This blame-shifting is unseemly. I think if my company sold GIAs it’d be a hell of a long time before Brigham & Women’s got any of my hardware.


Comments

  1. O.K., I’ll bite.
    The “hand-sewn” versus “stapled” debate has raged for years in the surgical community. Multiple studies have shown no difference in leak rate between sewn or stapled anastamoses. Not only have stapling devices made operations faster, but they have allowed lower levels of anastamosis in rectal cancer, avoiding a permanent colostomy. It basically comes down to the preference and skill of the surgeon. Personally, I staple in some areas, hand sew in others.
    I also find it unseemly that the hospital is so quick to blame the device. The enemy of any anastaomsis is tension, which could lead to breakdown. I have had staplers (VERY rarely) misfire before, and it always felt “funny” and I would re-enforce it some way. If they are sure the stapler did it, I wonder if they had concerns during the procedure?

  2. Did some more looking around on this case, and ranted on it here:
    http://cut-to-cure.blogspot.com/2003_11_01_cut-to-cure_archive.html#106847386265698395

  3. anonymous for now says:

    I had an open rny in october 2000. in March 2003, my staple line disrupted. A test done in April revealed a lower abdomen with 15-20 uncrimped, open staples in my pelvic area correlating exactly with my areas of pain. The stapler technology which staples and crimps is poor at best. And to top it off, my xrays which showed the staples are now so blurry that you can’t see squat. but luckily, I got a hold of them and showed them enough people that I have proof of what they used to look like. Now, I have 10 that are clear and 5 that are clouds. I have learned that there is only a small window of time that staples will come up on radiology and sometimes they NEVER DO. I had a friend who had staples in her pelvis for 13 YEARS! Luckily, she went into have a tummy tuck and they found them and had to DIG them out. It took her 3 months to stand again. So, why does this matter?

    Because, I was ordered to have an exploratory laporoscopy but now, no one will touch me because at least 7 doctors tried to hush this up. Radiologists that don’t report the staples, urologists that see the xrays and say, oh, your fine, go see your gyn. And then there is the surgeon that agreed to do the xlap, coded it and sent it off to the insurance company and then suddenly and without cause or warning, canceled the surgery and said as I cried and begged for him to help me, I don’t take out staples.

    It has now been 8 months. I have had 15 or so bladder infections, chronic pain, sex life ruined because it starts up the pain I work so hard to get under control, the atypical pap smears, etc.
    If you are a doctor, you better hope and pray you don’t try to hard to cover a mistake, because, the truth always finds you. Most people will understand if you are honest and tell them something is wrong and lets fix it, even if it is because they were too lazy to verify the staples were inserted with the correct technique, staple and crimp. My doctor was too busy to check and now I am paying the price.

    If you want to make a difference, this is your opportunity. I have researched it all and know every last detail of the danger of the stapler that malfunctions. It is so much more common than you think. If a patient is post bypass and complains of left lower quadrant pain, you had better rule out staple line disruption or you will break the 6th commandment in a matter of time. If you want to talk, call, I will be here waiting for someone to help.

    ANONYMOUS RN

    Ed:(number deleted; if you wish to contact this poster, please do so by email).