The reinforcement of the staples suture line can be made with different materials. The continuous enveloping suture of the entire line, including the omentum, may be best.
In our institution, we have a vast experience of patients operated with duodenal switch (DS) and laparoscopic vertical gastrectomy (LVG). We use a 12 mm intragastric probe as a guide and we de vascularize all the greater curvature passing pylorus.
We initiate the gastrectomy from the pylorus with sequential staplers up to the esophago-gastric junction and routinely try to prevent hemorrhages and leaks in the staple line with a reinforcing suture that includes omentum and the posterior and anterior gastric walls along the entire length of the gastric staple line. The objective of using the divided omentum together with the suture line is to avoid rotation of the gastric tube.