Abstract
Background
One prerequisite for the safe stapling of anastomoses is the formation of perfectly aligned B-shaped staples. Using an animal model, this study investigated whether precompression enhances secure staple formation.
Methods
A 45-mm linear stapler with a blue cartridge (staple leg length, 3.5 mm) was used on three portions each of six porcine stomachs (cardia, center, and pylorus). Staple shape and height were examined according to the precompression time (0, 1, or 5 min) before firing. The shape was classified as optimal or suboptimal, and the heights of the staples were measured individually. The completeness of the proximal staple lines also was compared with the distal lines.
Results
The optimal staple rate in the 5-min group (52.7%) was significantly higher than in the 1-min group (28.7%; p < 0.001) or the 0-min group (17.1%; p = 0.002). The optimal staple rate in the 5-min group for the cardiac portion (mean wall thickness, 2.7 mm) reached 98.9%. However, this rate was less than 50% in the center (5.3 mm) and pylorus (4.2 mm) portions regardless of the precompression time. Compared with the root side, the top side of the cartridge had a lower optimal rate (45.3 vs. 18.7%; p < 0.001). A high correlation of completeness was observed between the distal and proximal sides of the stump.
Conclusions
When a linear stapling device is used, proper staple formation is correlated with intestinal wall thickness, and a sufficient amount of precompression time is effective for gaining the secure staple formation.
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References
Ravitch MM, Brown IW, Daviglus GF (1959) Experimental and clinical use of the Soviet bronchus stapling instruments. Surgery 46:97–108
Androsov PI (1963) New instruments for thoracic surgery. Dis Chest 44:590–597
Manufacturer’s instruction for use by Ethicon Endo-Surgery Inc., Cincinnati, OH, USA
Wind J, Safiruddin F, van Berge Henegouwen MI, Slors JF, Bemelman WA (2008) Staple line failure using the Proximate 100-mm linear cutter. Dis Colon Rectum 51:1275–1278
Offodile AC II, Feingold DL, Nasar A, Whelan RL, Arnell TD (2010) High incidence of technical errors involving the EEA circular stapler: a single institution experience. J Am Coll Surg 210:331–335
Morita K, Maeda N, Kawaoka T, Hiraki S, Kudo A, Fukuda S, Oka M (2008) Effects of the time interval between clamping and linear stapling for resection of porcine small intestine. Surg Endosc 22:750–756
Kawasaki K, Fujino Y, Kanemitsu K, Goto T, Kamigaki T, Kuroda D, Kuroda Y (2007) Experimental evaluation of the mechanical strength of stapling techniques. Surg Endosc 21:1796–1799
Goto T, Kawasaki K, Fujino Y, Kanemitsu K, Kamigaki T, Kuroda D, Suzuki Y, Kuroda Y (2007) Evaluation of the mechanical strength and patency of functional end-to-end anastomoses. Surg Endosc 21:1508–1511
Yo LS, Consten EC, Quarles van Ufford HM, Gooszen HG, Gagner M (2006) Buttressing of the staple line in gastrointestinal anastomoses: overview of new technology designed to reduce perioperative complications. Dig Surg 23:283–291
Ahmed S, Hanna GB, Cuschieri A (2004) Optimal angle between instrument shaft and handle for laparoscopic bowel suturing. Arch Surg 139:89–92
Memon AA, Marks CG (1996) Stapled anastomoses in colorectal surgery: a prospective study. Eur J Surg 162:805–810
Wheeler JM, McC Mortensen NJ (1998) Reconstructive rectal surgery. Surg Oncol 7:13–23
Acknowledgments
This study was conducted under the Kyoto University Sponsored Research Program (SRP) supported by Johnson & Johnson K.K., Ethicon Endo-Surgery, Japan.
Disclosures
Shinya Nakayama, Koya Hida, and Dr. Eiji Tanaka received financial and technical support to perform the experiment by Ethicon Endo-Surgery. Yoshiharu Sakai, Hajime Kubo, Atsushi Itami, Shigeru Kato, Suguru Hasegawa, and Satoshi Nagayama have no conflicts of interest or financial ties to disclose.
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Nakayama, S., Hasegawa, S., Nagayama, S. et al. The importance of precompression time for secure stapling with a linear stapler. Surg Endosc 25, 2382–2386 (2011). https://doi.org/10.1007/s00464-010-1527-7
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DOI: https://doi.org/10.1007/s00464-010-1527-7