What is the Double Buttress Technique? The DBT
As medical professionals we are taught to frequently question the status quo. I personally am always looking for ways to improve quality, safety and outcomes. This is something we have built into our practice and and to the mentality of our team at OCC. This is part of the OCC DNA and it is centered around the patient and how we can improve constantly at every level. But what does this have to do with a surgical technique you ask?
The Double Buttress Technique (DBT) is the result of a 20 plus year accumulated experience in over 22,000 patients that have undergone weight loss surgery at our facility. As new procedures are introduced into the world of surgical weight loss, there is an associated learning curve to be tackled. These newer procedures not only have to pass the test of time, they also have to be re-evaluated to address the undesirable effects and complications of the technique. The sleeve has been around for a couple of decades and in this time is has shown to be a safe and effective technique when performed by expert hands. During its early years it was associated to a devastating complication know as a gastric leak. The procedure requires a long stapling line that divides the stomach vertically creating a sleeve like looking stomach and sectioning off the excess and removing it. This long staple line is created by a mechanical stapling device that is not infallible. The stapler deposits three rows of thousands of titanium staples closing the edges of the stomach shut. Though infrequent, a staple line break down can happen, letting the gastric acid leak out and free flow into the abdomen, resulting in a peritonitis, a life threatening complication. Ever since day one, we have questioned the regular techniques and have always tried to improve them. This is the story of the traditional gastric sleeve and the DBT, developed specifically to reinforce the row of minute staples that are literally hanging by a thread and keeping that gastric acid where it belongs.
One is good, two is better.
The DBT is a second seal over the staple line, a ziploc® style closure if you will. It sounds logical doesn’t it? Well it worked! The DBT does several things as we have found out by following patients for years after the procedure. It seals, it reinforces and micro-calibrates.
Over the past decades we have followed thousands of patients and have never encountered a gastric leak. We not only follow-up our patients for five years, we educate them before the surgery on any alarm signs they may encounter. So our follow-up program is specifically designed so patients can recognize any type of complications early on sometimes even before they develop. We are happy to report that because we have never experienced a leak we have stopped the use of drains altogether several years ago even on revision surgeries!
As a seal the DBT has proven its value. After regular followup we discovered that the DBT also plays a role in preventing the stretching of the gastric wall and failure of the procedure. This was a simple comparative observation of those patients who had undergone a sleeve procedure elsewhere and our series of patients. Those that didn’t have the DBT had a higher rate of failure and weight regain, something that is not prevalent in OCC sleeved patients.
Followup has its benefits. For starters, it keeps the patient safe and well informed. It also can detect potential problems before they happen. Lastly and most importantly, it is the best way to measure how the DBT improves upon the conventional technique by creating a better seal and reinforces the sleeve. When the DBT was designed, a concept that was also envisioned early on was the micro-calibration of the sleeve. A procedure that is symmetrical and regular in its length and width is less prone to strictures, widening or torsion at its’ axis. Calibration of the sleeve can be subjective but micro-calibration will result in a better gauged procedure with more measurable outcomes. We evaluate patients returning for x-ray imaging at our center and their sleeves are more symmetrical and have less stretching effect than conventional sleeves. These last two have been closely associated to better more permanent weight loss at our center.
The DBT is part of the IGS® The Improved Gastric Sleeve, a safer, more effective weight loss tool, an OCC exclusive.