Intraluminal migration of bovine pericardial strips used to reinforce the gastric staple-line in laparoscopic bariatric surgery

A 41-year-old morbidly obese woman (BMI 40.8) underwent elective laparoscopic biliopancreatic diversion with duodenal switch. The operation involved: sleeve gastrectomy, division of duodenum, creation of a duodenoenterostomy, and creation of a distal ileoenteric anastomosis. With laparoscopic stapling, bleeding is often a problem along the sleeve gastrectomy staple-line. To reduce this risk, we used bovine pericardial strips to reinforce the staple-line throughout its length. 4 weeks postoperatively, the patient was found to have fragments of pericardium in her vomitus, indicating intraluminal migration of the reinforcing strips. Her subsequent course has been uneventful. This represents the first report of such migration. Indications, benefits, complications and risks of using bovine pericardium to reinforce gastric staple-lines in laparoscopic bariatric surgery are discussed.