Improving the side-to-side stapled anastomosis: comparison of staplers for robust crotch formation

Abstract

Background: Few studies have investigated the burst pressure of side-to-side anastomoses comparing different stapling devices that are commercially available.

Objectives: We conducted side-to-side anastomoses with a variety of staplers and compared burst pressure in the crotch of the anastomoses.

Setting: Nagoya City East Medical Center.

Methods: We conducted side-to-side anastomoses with 9 staplers with different shapes and forms. Fresh pig small intestines were used. A side-to-side anastomosis was performed between 2 intestine specimens using a linear stapler. The burst pressure of the anastomosis was recorded.

Results: In total, 45 staplers were used for this experiment. The site of leakage in all cases was the crotch. Regarding the influence of the number of staple rows, the burst pressure in 3-row staplers was significantly higher than in 2-row staplers. With regard to the relationship between staple height and burst pressure, staples with a height slightly shorter than the intestinal thickness showed the highest burst pressure. In a comparison of staplers with uniform staple heights and stamplers with staples of 3 different heights, the latter had significantly lower burst pressures. Neoveil significantly increased the burst pressure in the crotch and contributed to the highest burst pressure of all the staplers used in this experiment.

Conclusions: In this experiment, we defined the important factors that influence burst pressure at the crotch of a stapled, side-to-side anastomosis. These factors include the number of staple rows, the height of the staple compared with the thickness of the tissue, uniformity of staple height, and reinforcement of the staple line. In any surgical case requiring intestinal anastomosis, selection of a stapler is a critical step.

Keywords: Crotch; Pressure resistance; Side-to-side anastomosis; Stapler.