ABSTRACT
The “Type of Article” of this paper is “Letter to the Editor”. This paper discuses about: “Relationship between the Characteristics of Staplers and Malformation of Staples”. No formal abstract is available. Readers are requested to read the full article.
ABSTRACT
Introduction: The improvement of stapling devices has been remarkable. As the stapler evolved from two lines to three lines of staples, the lateral strength of the anastomosis increased. However, the strength of the crotch did not change and the crotch remains the weak point of the side-to-side anastomosis. We previously reported the weakness of the crotch and the reinforcement method with animal model [1,2]. Technique: We describe our novel technique to reinforce the crotch using a physician-modified stapling device. A stapler with three rows of staples per side is arranged on a 6 cm segment using an EndoGIA Reinforce. Polymer felt is attached to both the cartridge fork and anvil fork of the stapler. The felt is then trimmed, as a length of 2 cm is sufficient for reinforcement of the crotch. Results: With this method, we can reinforce the weak point of the side-to-side anastomosis at the same time as the anastomosis. Conclusions: This method is a simple and novel technique to reinforce the crotch of a side-to-side anastomosis.
ABSTRACT
Background: In gastrointestinal surgery, the quality of anastomosis is one of the most important factors influencing the postoperative course. The purpose of this study was to verify the effectiveness and the mechanism of one type of reinforcement material. Methods: We analyzed the effect of NeoveilⓇ on the rate of staple line failure. Fresh pig small bowel was used. NeoveilⓇ sheets were placed on the anvil alone, cartridge alone or both sides of the stapler. Groups were: A, without NeoveilⓇ; B, the cartridge and anvil; C, the cartridge alone; D, the anvil alone. The burst pressures were measured. Results: In group A, a leak occurred at the intestinal stump in 5 of 10 cases (As). In the other 5 cases, the mesenteric side burst before failure of the staple line (Am). In groups B, C, and D, the mesenteric side burst before failure of the staple line. The median leak pressure was 100±46 mm Hg in group A (As; 57±6, Am; 143±12). In the other groups, the leak pressures were approximately 140 mm Hg. In group As, the middle staple only exists on the edge of stump. In group Am, however, both sides of the 3-row staple line exist on the edge of stump. Conclusion: The burst pressure of the stump became the result of the bipolarization. The strength of the stump staple line is affected by the arrangement of the staples. NeoveilⓇ was effective in obtaining a stronger staple line.