Sorry this is far longer than I thought it would be. Maybe the illustration will help others visualize hte operation even if no one knows the answer to my question.

So I've been here almost 2 years now, I think I have a pretty good grasp on how the VSG is done but one thing escapes me: How do the sheared off stomach tissues heal together?

So picture this, take a regular white sock, say for arguments sake it's PINK on the inside and WHITE on the outside. Cut a small hole in the toe. This is your stomach, the cuff is your esophagus, the hole in the toe is where it is joined to the intestines at the pyloric valve. The heel (which should be to the RIGHT as you look at it to be anatomically correct) is the pendulous, the part that is cut off.

So during the operation a bougie, a long thin soft rod like thing is stuck down your throat and just barely into the intestinal tract (the hole in the toe). Let's say this is just a piece of clear tubing about as big around as a Sharpie marker. The surgeon uses an alligator looking stapler that has a sliding razor blade in it and clamps it across diagonally from below the hole in the toe to the lower area of the cuff - which cuts off the heel of the sock. The bougie ( clear tube ) is there to prevent the surgeon from accidentally cutting the stomach too small or possibly cutting the esophagus ( cuff) or pyloric exit ( hole in the toe ) off completely. The stapler is NOT snugged up against the bougie ( clear tube) but the doc just uses it to prevent cutting too much and to allow him to flop the stomach around and keep it taught. he pulls a trigger on the alligator cutting / stapling tool bites down and the blade slide UP the alligators mouth cutting both the near AND far sides of the stomach tissue ( sock ) while pressing hundreds of tiny little staples right through BOTH parts of the sock cleanly. Just like a staple in the corner of two pieces of paper only about 20 times smaller and in 3 rows side by side. He may have to reload his alligator like tool because the part he is cutting off is longer than the alligators mouth. He again lines the tool up where the first cut let off and pulls the trigger again, this time it cuts the pendulous ( heel ) right off. He now has a stomach ( sock ) without a heel that has a cut edge and is held together with tiny little staples. The stomach tissue is about as thick as two pieces of salami laying on top of each other. The cut off part ( heel ) is floating there freely all sealed up in a pouch as this alligator has TWO rows of teeth and the razor blade runs down the middle. He grabs it with his tools and pulls it out of the largest of the few holes he punctured in your belly.

Now for the part that I don't understand. Remember we said the sock is PINK on the inside and WHITE on the outside. Well her is this sleeved stomach with the heel cut off and the edge of the tissue being held together by a row of staples PINK SIDE TO PINK SIDE. that is UNCUT tissue. Now your stomach or most any other tissue does not normally stick to or heal together and form scar tissue when stuck together, so HOW and WHY do the inside surfaces of the stomach heal together? Is it the hundreds of tiny pin prick sized holes of the staples? Is it just the raw EDGES (not surfaces) of the tissue being held in close proximity that will produce scar tissue joining the edges and seal the the stomach?

Inquiring minds want to know.

Ok..nerd here..this may answer your questions. Box three has great explanation as to why dehiscence(meaning the surgical wound doesn't heal) happens...if the stuff in box three doesn't occur then the wound heals..hope this helps..if not..I will see if I can dive a little farther into medical manuals!

http://www.woundsinternational.com/pdf/content_65.pdf

Pipula, please take no offense, and I apologize if I missed it in your referenced article, but I don't find the answer to rootman's question there. He is asking HOW the edges of the stomach heal when the raw or wounded edges are not touching. The article explains howthe raw or wounded edges might NOT heal, as far as I can tell. Or did I miss something?

Yes, inquiring minds do need to know! Rootman, I thought they also used some sort of adhesive? Or did I dream that up?

Well quiet simply cell regeneration is the answer. In box 3 ..it does give the answers in reverse order.

Ok try looking up granulation of a wound..that is where you have an open wound and the tissue regenerates at the base of the wound essentially filling In the wound..perhaps that is a better explanation.

I'm no doctor or nurse but worked many years in the veterinary field. Maybe it can be compared to some of the bone growth I have seen first hand after horrible fractures that were pinned and wired but still had big chunks missing. Open voids....and amazingly, the body filled them in with new bone!

Can't put it in any fancy terms, but I think the stomach wants to try to return to as normal a state as it can, and will form a tissue "bridge" over the injured area. I remember reading somewhere that after a while the staples will even be covered over.