In current surgical practice, the majority of the anastomoses is performed using a stapling device. Despite correct usage, staple line failure might still occur.
Concerning surgical stapling devices, the United States Food and Drug Administration (FDA) received reports of 22,804 malfunctions, 2,180 injuries, and 112 deaths from 1992 to July 1, 2001. These numbers included all types of linear and circular stapling devices as well as clip appliers. The majority of operations reported were gastrointestinal. Failure of stapling devices to function resulted in suture line separation or leak as the most common problem. When interpreting these data, it should be borne in mind that besides the fact that staplers are used very frequently, surgeons have to know the appropriate surgical techniques to inspect and verify staple line defects, and the techniques to employ if issues occur especially when performing complex surgery such as in this case of NOTES sleeve gastrectomy.
Thanks to the high skills of the surgeon, the procedure was completed using only one further port.

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