In-continuity gastrointestinal stapling

Abstract

Several surgical procedures have been proposed to interrupt continuity of the gut, without transection, by means of a row of staples. Using the dog, we investigated the functional and histologic results of incontinuity stapling of the gastric antrum, the small intestine, and the colon. After creation of an end antrostomy, ileostomy, or colostomy, a staple line was placed proximal to the stoma (TA 55-4.8 mm staples). Decompression of the bowel proximal to the staple line was accomplished by an enteric anastomosis. Separation of the staple closure was detected by intestinal contents exiting from the stoma. Animals were sacrificed at the time of disruption, and specimens were obtained for histologic examination.

Three of five antral closures broke down at a mean of 19.6 days after operation. All five small-bowel staple lines opened at a mean of 12.4 days. Five of five colonic staple lines disrupted 13.0 days postoperatively. The staples pulled through the bowel wall without losing their “B” shaped configuration. Microscopic examination showed intact mucosa across the staple line, with no submucosa to submucosa healing.

Staple lines in the undivided small bowel or colon disrupt after approximately two weeks, due to lack of fibrotic healing. Staple interruptions of the gastric antrum also disrupt, but with less regularity.