Increased Burst Pressure in Gastrointestinal Staple-Lines using Reinforcement with a Bioprosthetic Material

Abstract

Reinforcement of stapled GI anastomoses with SIS significantly increases anastomotic burst pressure. These findings suggest a role for this material in GI surgery.

Use of staple-line reinforcement in laparoscopic gastric bypass surgery: a meta-analysis

“…The buttressing effect of this reinforcement can increase the burst pressure of staple-line and thereby may reduce the incidence of anastomotic leak [16,[33][34][35]. Furthermore, inclusion of the SLR within the staple-line increases the tissue thickness and might decrease bleeding by making the staple-line tighter [13,27,28].…”

Buttressing Staples with Cholecyst-derived Extracellular Matrix (CEM) Reinforces Staple Lines in an Ex Vivo Peristaltic Inflation Model

“…Reinforcing the staple lines with buttressing materials has been shown in pre-clinical studies 17,23,25,26 as well as clinically to be effective in preventing staple line leakage and bleeding. 4,22,33 In a typical ex vivo setup using porcine small intestine for testing staple line integrity, a continuous pumping of solution exerts increasing intraluminal pressure that leads to the failure of staple lines and/or intestinal tissue.…”

“…4,22,33 In a typical ex vivo setup using porcine small intestine for testing staple line integrity, a continuous pumping of solution exerts increasing intraluminal pressure that leads to the failure of staple lines and/or intestinal tissue. 17,23 The failure of staple lines starts as a leak. Depending on the rate of leak, either the staple lines fail or the intestines rupture -usually at the mesentery.…”

“…Examples of clinically available buttress reinforcement materials are bovine pericardium (Peri-strips ® ), [15][16][17][18][19] expanded-polytetrafluoroethylene (ePTFE ® ), 18,20 polyglycolic acid (PGA)-trimethylene carbonate (TMC) copolymer (Gore Seamgaurd ® ) 21,22 and small intestinal submucosa (Surgisis ® ) [23][24][25][26] . These products have demonstrated some success in reducing leakage and bleeding complications associated with staple lines.…”

A comparison of gastrojejunal anastomoses with or without buttressing in a porcine model

“…Potential drawbacks related to staple-line reinforcement include increased cost, the potential for increased operative time, and training issues related to the surgeon and nursing staff so that device is used properly. Staple-line reinforcement materials that have demonstrated good safety and efficacy include BSG [15-18, 24, 25], bovine pericardium [12,13,[26][27][28][29], small intestine submucosa (SIS, Surgisis Ò , Cook, Inc. Bloomington, IN) [30][31][32], and expanded polytetrafluoroethylene [28,29]. The majority of these studies have been human trials where histologic and mechanical evaluations of the anastomoses are impossible; therefore, little is known about the true impact of these materials on anastomoses.…”