Initial Assessment of Mucosal Capture and Leak Pressure After Gastrointestinal Stapling in a Porcine Model.

BACKGROUND: Anastomotic leak is a leading cause of morbidity and mortality in gastrointestinal surgery. The serosal aspect of staple lines is commonly observed for integrity, but the mucosal surface and state of mucosa after firing is less often inspected. We sought to assess the degree of mucosal capture when using stapling devices and determine whether incomplete capture influences staple line integrity. METHODS: Porcine ileum was transected in vivo and staple lines were collected and rated for degree of mucosal capture on a 5-point scale from 1 (mucosa mainly captured on both sides) to 5 (majority of mucosa not captured). Mucosal capture was also assessed in ex vivo staple lines, and fluid leakage pressure and location of first leak was assessed. Stapling devices studied were Echelon Flex GST with 60-mm blue (GST60B) and green (GST60G) cartridges, and Medtronic EndoGIA Universal with Tri-Staple Technology™ with 60 mm medium (EGIA60AMT) reloads (purple). RESULTS: GST60B and GST60G staple lines produced significantly better mucosal capture scores than the EGIA60AMT staple lines (p < 0.001, in all tests). Compared to EGIA60AMT, leak pressures were 39% higher for GST60B (p < 0.001) and 23% higher for GST60G (p = 0.022). Initial staple line leak site was associated with incomplete mucosal capture 78% of the time. CONCLUSIONS: There are differences in degree of mucosal capture between commercial staplers, and the devices that produce better mucosal capture had significantly higher leak pressures. Further research is needed to determine the significance of these findings on staple line healing throughout the postoperative period.

An effective, economical method of reducing environmental noise in the vivarium.

High levels of ambient noise can have detrimental effects on laboratory animal wellbeing and may affect experimental results. In addition, excessive noise can reduce technician comfort and performance. This study was performed to determine whether inexpensive, passive acoustic noise abatement measures could meaningfully reduce noise levels. Sound level measurements for various activities were obtained in the incoming processing room for pigs before and after installing gypsum acoustic paneling, covering metal-to-metal contact points with strips of adhesive-backed rubber, and replacing hard plastic wheels on transport carts with neoprene wheels. The modifications reduced the overall average noise level by 8.1 dB. Average noise levels for each activity were all less than 85 dB after the modifications. Average noise levels can be reduced effectively and economically with passive abatement methods. Intermittent spikes in noise are more difficult to control and may require attention to the individual activity.