As widely recognised already, the antrum is the thickest area of the stomach encountered upon gastric stapling. The average thickness of the antral wall is 5 +/-1mm but the range is great as 1-18mm in healthy normal tissue.
Due to this fact, upon performing a laparoscopic gastric sleeve, some opt to; forego buttressing, use a greater staple height or minimise antral stapling all together.
A posterior pre-pyloric pleat or the staple saboteur (as we call it) has been identified at the routine dissection of the omental from the antrum.
By unfolding this pleat prior to stapling, the antrum becomes immediately visibly less thick allowing for easier and therefore theoretically safer stapling of this area.
Videos provided.