Enhancing Sleeve Gastrectomy Outcomes with the Help of a Single-Fire Stapler
General Surgery News, Special Report, April 2026
John Morton, Jon Schram, Tanyaradzwa M. Kajese, Forrest Ringold, Helmuth T. Billy, and Richard M. Peterson
The Titan SGS™ Stapler and
the link to real-world outcomes
From early adoption of the anatomy-based approach (ABA) through the single-fire stapler design, real-world clinical information has shaped each step of the development of the Titan SGS™ Stapler. Retrospective data continues to demonstrate positive outcomes associated with the Titan SGS™ Stapler.
The shape of bariatrics today
Millions are living with obesity and the health consequences. Yet only a small portion choose bariatric surgery. For those who pursue surgery, sleeve gastrectomy is the most widely performed procedure of its type globally.3
“There are 40 to 50 million people who could benefit from sleeve gastrectomy, but the procedure is underutilized.”
John Morton,
MD, MPH, MHA, FACS, FASMBS*
*Dr. Morton is a paid consultant of Teleflex.
The challenge: Variability in sleeve shape
Variations in laparoscopic sleeve gastrectomy technique can lead to differences in sleeve shape. Achieving a consistent sleeve morphology may be associated with improved outcomes.
“Consistently providing my patients with optimal outcomes requires reproducibility in my surgical technique and the shape of the sleeves I create.”
Tanyaradzwa M. Kajese,
MD, FACS, FASMBS*
*Dr. Kajese is a paid consultant of Teleflex.
The solution to variations in technique: An anatomy-based approach (ABA)
By establishing the desired outcome with respect to key anatomical landmarks, surgeons in the Standard Sleeve Project5 identified a way to standardize sleeve gastrectomy and improve reproducibility.
“When the anatomy-based approach was proposed in 2017, I realized it was a paradigm shift, and I quickly began using it.”
Jon L. Schram,
MD, FACS, FASMBS*
*Dr. Schram is a paid consultant of Teleflex.
THE TECHNOLOGY: A SINGLE-FIRE TITAN SGS™ STAPLER
The single-fire Titan SGS™ Stapler is purpose-built to help create an optimal sleeve shape for laparoscopic sleeve gastrectomy.7,8
*The Ying et al. study is a retrospective study. The results are not necessarily definitive. Dr. Morton and Dr. Ringold, two of the authors of the study, are paid consultants of Teleflex.
“From a procedural standpoint, [the Titan SGS™ Stapler] helps to reduce variability from case to case and allows me to achieve consistent, reproducible, and optimized sleeve morphology…”
Forrest Ringold,
MD, FACS, FASMBS, DABS-FPMBS*
*Dr. Ringold is a paid consultant of Teleflex.
“In my experience, which is consistent with published data, … with the single-fire stapler…there is a reduction in post-operative nausea, vomiting, and GERD, compared with multi-fire staplers.”
Helmuth Billy,
MD*
*Dr. Billy is a paid consultant of Teleflex.
Shaping the future
“…in my experience, choosing the single-fire stapler helps me overcome several important challenges and helps me achieve better outcomes for my patients.”
Richard Peterson,
MD, MPH, FACS, FASMBS,
DABS-FPMBS*
*Dr. Peterson is a paid consultant of Teleflex.
Morton JM, Schram J, Kajese TM, Ringold F, Billy HT, Peterson RM. Sleeve shape matters: enhancing sleeve gastrectomy outcomes with the help of a single-fire stapler. Gen Surg News. April 2026;(Special Report).
This white paper is a summary of retrospective studies. Results from retrospective studies may not be indicative of clinical performance or outcomes. All authors are paid consultants of Teleflex. Teleflex funded the drafting of the white paper.
Additional Studies & Releases
Our Titan SGSTM Stapler has been featured in many studies and publications. Click the links below to navigate to the publications where these studies and releases can be found.
Check back often for the latest outcomes associated with the Titan SGS™ Stapler as you and your VAC make decisions about the most effective tools for sleeve gastrectomy.
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This information is provided for clinical education purposes and is not intended to be a substitute for sound clinical judgment or decision making, or professional experience relative to diagnostic and treatment options of a specific patient’s medical condition. The above pictured physicians are paid consultants of Teleflex. Each of their statements reflect his or her personal experiences and opinions.
This white paper is a summary of retrospective studies. Results from retrospective studies may not be indicative of clinical performance or outcomes.
All authors are paid consultants of Teleflex. Teleflex funded the drafting of this white paper.
- World Health Organization. Obesity and overweight. December 3, 2025. Accessed March 12, 2026. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.
- English WJ, DeMaria EJ, Brethauer SA, et al. American Society for Metabolic and Bariatric Surgery 2020 estimate of metabolic and bariatric procedures performed in the United States. Surg Obes Relat Dis. 2022; 18(9): 1134-1140.
- Angrisani L, Santonicola A, Iovino P, et al. IFSO worldwide survey 2020-2021: Current trends for bariatric and metabolic procedures. Obes Surg. 2024;34(4):1075-1085. doi: 10.1007/s11695-024-07118-3.
- Dhar VK, Hanseman DJ, Watkins BM, Paquette IM, Shah SA, Thompson JR. What matters after sleeve gastrectomy: patient characteristics or surgical technique? Surgery. 2018;163:571-577. DOI: 10.1016/j.surg.2017.09.052.
- Thompson J, Dhar V, Hanseman D, Watkins B, Morton J, Diwan T. Anatomy-based laparoscopic sleeve gastrectomy reduces gastroesophageal reflux disease compared to laparoscopic sleeve gastrectomy with bougie. Surg Obes Relat Dis. 2017;13:S110.
- Ying L, Rutledge R, Butensky S, Lugo DF, Morton J, Ringold F. Does stapling platform influence robotic sleeve gastrectomy postoperative outcomes? Obes Surg. 2025;35(5):1838-1844. DOI: 10.1007/s11695-025-07855-z. Retrospective study – results from retrospective studies may not be indicative of clinical performance or outcomes. Dr. Morton and Dr. Ringold are paid consultants of Teleflex.
- Toro JP, Lin E, Patel AD, et al. Association of radiographic morphology with early gastroesophageal reflux disease and satiety control after sleeve gastrectomy. J Am Coll Surg. 2014;219(3):430-438. doi:10.1016/j.jamcollsurg.2014.02.036.
- U.S. Food and Drug Administration. 510(k) Premarket Notification: K210278. Published April 28, 2021.
- Morton JM, Schram J, Kajese TM, Ringold F, Billy HT, Peterson RM. Sleeve shape matters: enhancing sleeve gastrectomy outcomes with the help of a single-fire stapler. Gen Surg News. April 2026;(Special Report). This white paper is a summary of retrospective studies. Results from retrospective studies may not be indicative of clinical performance or outcomes. All authors are paid consultants of Teleflex. Teleflex funded the drafting of this white paper.
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