I have the following comment.
It is not necessary to divide between the pouch and the fundus of the stomach after a vertical banded gastroplasty to prevent late disruption of the staple line. It is only necessary to use a four-layer stapler. Then, with the double-gloved finger behind the staple line, it is only necessary to penetrate the tissue that lies between the two middle staple lines with the needle tip of the electrocautery and switch on the current for approximately 1 s until a burn appears around the cautery point. If this is repeated approximately every 3 or 4 mm, the result is a series of full-thickness injuries which in time becomes a 'spot weld' at the staple line.
No method, not even dividing the two compartments, can prevent early dehiscence. This method can prevent long-term dehiscence and, in the 3 or 4 years I have been using it, I have had no staple line breakdowns in approximately 20 patients.
This method was inspired by a report of an Australian surgeon who, working in the outback using dingoes as an experimental animal, found that horizontal gastroplasty staple lines could be made to outlast the voracious eating habits of these animals if an older model stapler was used, screwed down as tightly as possible on the stomach and allowed to remain for 30 min before setting the staples. I concluded that full-thickness necrosis is necessary to prevent late separation. I have forgotten this hero's name and, if he reads this, I hope he will accept my congratulations. If I remember correctly, he did the research at his own expense.