Evaluation of staple line reinforcement after partial gastrectomy closure in an ex vivo canine model

Abstract

Objective: To determine the influence of stapling on leakage pressures after canine partial gastrectomy. Study design: Ex vivo study. Sample population: Gastric specimens from 24 adult canine cadavers. Methods: Partial gastrectomy constructs were assigned to one of three closure techniques (n = 8 per group): group 1, stapled closure with a 90-mm thoracoabdominal stapling device and a 4.8-mm staple cartridge; group 2, hand-sewn double-layer inverting suture closure with 3-0 glycomer 631; and group 3, staple line reinforcement with an inverting Cushing suture pattern. Leakage and pressure testing were performed. Initial leakage pressure (ILP), maximal leakage pressure (MLP), and leakage location were recorded. Significance was set at P < .05. Results: Placement of a Cushing suture (group 3) increased ILP and MLP by 3.2-fold and 2.8-fold, respectively, compared with stapled closures alone (P < .001). Constructs closed with double-layer suture closure reached ILP and MLP 4.5-fold and threefold greater, respectively, compared with those with stapled closures alone (P < .001). Maximal leakage pressure did not differ between groups 2 and 3 (P = .14). Leakage occurred from the inverting suture line in all constructs of groups 2 and 3 and from staple holes in six of eight group 1 constructs. Conclusion: Double-layer suture closure of canine partial gastrectomies achieved superior biomechanical properties compared with stapled closure techniques. Reinforcing staple closures with an inverting suture line improved resistance to leakage. Clinical significance: Reinforcing single-layer closure of partial gastrectomies with an inverting Cushing pattern is recommended to improve resistance

Ex vivo comparison of different thoracoabdominal stapler sizes for typhlectomy in canine cadavers

“…Initial leak pressure was the only pressure evaluated and maximal leak pressure testing was not performed. A type II error is possible; however, the number of samples evaluated was similar to previously reported data 16,17 . An additional limitation is related to our use of cadavers and our inability to account for enteric wound healing, fibrin deposition, or the impact of omentalization at the typhlectomy site.…”

“…A type II error is possible; however, the number of samples evaluated was similar to previously reported data. 16,17 An additional limitation is related to our use of cadavers and our inability to account for enteric wound healing, fibrin deposition, or the impact of omentalization at the typhlectomy site. The large standard deviation seen for the TA 30 V3 group may have complicated detection of a significantly higher ILP in comparison with the other groups.…”

“…Comparatively, more information is available for leak testing in the small intestine than the large intestine and cecum 11–14 . Previous reports have described the use of linear staplers, the effect of staple line offset, and suture augmentation or use of a suture oversew on staple line leak pressure for gastrointestinal surgery in dogs and cadaveric tissues 2,13–17 . A recent paper by Duffy et al described the use of a gastrointestinal anastomotic stapler (GIA) (3.8 mm) for typhlectomy in canine cadavers 17 .…”

Staple line reinforcement for intracorporeal anastomosis reduces time for reconstruction during laparoscopic gastrectomy for gastric cancer Running Τitle: Staple line reinforcement for gastric cancer

“…Various staple line reinforcement (SLR) techniques have been developed for clinical use to reduce the occurrence of incisional leakage [3,4]. Different techniques for SLR have been reported, which include oversewing the staple line, brin glue application, use of bioabsorbable buttressing material, and omental or jejunal wrapping [5]. Recently, a novel SLR, which can be applied as a bioabsorbable material in a conventional linear stapler, was developed to reduce the incidence of early staple line complications.…”

Ex vivo comparison of hand‐sutured versus circular stapled anastomosis in canine large intestine

“…Relative rates of colonic leakage following colectomy are currently not well established in small animals, but a secure closure is of the utmost importance due to the high bacterial load in the large intestine 5 . Current gastrointestinal stapling techniques include the use of a gastrointestinal anastomosis (GIA) stapler with a thoracoabdominal (TA), 6–11 an end‐to‐end anastomosis (EEA), 2,3 or an anastomosis with skin staplers 12 . In man, studies comparing hand‐suturing to stapling of colonic and ileocolic resection and anastomosis reporting conflicting results regarding the relative risks of leakage between closure techniques 13–17 .…”