To the Editor.—The recent article by Bluett et all that evaluates staple lines in gastric surgery was most interesting and informative. I write to protest regarding the Invited Editorial Comment at the end of the article.
I would like to know how Dr Ravitch arrived at his conclusions. It may well be that the bursting pressures' and resistance to tension disruption are irrelevant to the clinical situation in the vast majority of gastrointestinal operations, as the forces are disproportionate to the physiologic stresses. However, with bariatric surgery, this is certainly not the case. It would seem logical to assume that the pressures to which the staple line and proximal pouch are subjected after, eg, Mason vertical banded gastroplasty, are going to be high, particularly in these difficult, often noncompliant patients. The exact magnitude of these pressures is unknown, but if the stoma does become obstructed, it is possible that