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

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Abstract

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.

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Funding

This study was funded by and all authors were employees at the time of the study of Ethicon, Inc.

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Authors and Affiliations

  1. Ethicon, Inc., 4545 Creek Rd, Cincinnati, OH, 45242, USA

    Suzanne E. Thompson, Maggie T. Young, Michelle T. Lewis, Steven M. Boronyak, Jeffrey W. Clymer, Elliott J. Fegelman & Deborah A. Nagle

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  1. Suzanne E. Thompson
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  2. Maggie T. Young
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  3. Michelle T. Lewis
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  4. Steven M. Boronyak
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  5. Jeffrey W. Clymer
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  6. Elliott J. Fegelman
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  7. Deborah A. Nagle
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Corresponding author

Correspondence to Jeffrey W. Clymer.

Ethics declarations

All in vivo procedures and animals used in this study were pre-approved by the Institutional Animal Care and Use Committee.

Conflict of Interest

This study was funded by and all authors were employees at the time of the study of Ethicon, Inc.

Ethical Approval

All applicable institutional and/or national guidelines for the care and use of animals were followed.

Informed Consent

Informed consent does not apply in this study.

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Thompson, S.E., Young, M.T., Lewis, M.T. et al. Initial Assessment of Mucosal Capture and Leak Pressure After Gastrointestinal Stapling in a Porcine Model. OBES SURG 28, 3446–3453 (2018). https://doi.org/10.1007/s11695-018-3363-0

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  • DOI: https://doi.org/10.1007/s11695-018-3363-0

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