Intestinal mucosa staple line integrity and anastomotic leak pressure after healing in a porcine model

Naoi, Daishi; Horie, Hisanaga; Koinuma, Koji; Kumagai, Yuko; Ota, Gaku; Tojo, Mineyuki; Kaneda, Yuji; Hishikawa, Shuji; Sadatomo, Ai; Inoue, Yoshiyuki; Fukushima, Noriyoshi; Lefor, Alan Kawarai; Sata, Naohiro

doi:10.1007/s00595-021-02267-9

Cited by 4 publications

(3 citation statements)

References 30 publications

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“…In contrast, in a porcine model, the integrity of the mucosal staple lines was associated with the postoperative leak pressure on day 0. However, there was no association with the leak pressure from postoperative day two (16). A lack of a statistically significant difference in the leak rate in laparoscopic sleeve gastrectomy with or without staple-line reinforcement was reported (17).…”

Section: Discussionmentioning

confidence: 94%

Does Intestinal Peristalsis Cause Suture Failure After Instrument Suture?

Rino

Aoyama

Maezawa

et al. 2023

In Vivo

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Background/Aim: Gastrectomy with lymphadenectomy is a standard treatment for gastric cancer. Anastomotic leakage remains a potentially fatal complication of gastrectomy. Forceful stapler extraction may cause anastomotic complications. We focused on the duodenal peristalsis, as we hypothesized that it might cause forceful stapler extraction. We then retrospectively investigated duodenal peristalsis and reviewed videos of Da Vinci system cases to clarify the relationship between peristalsis and anastomotic complications. Patients and Methods: Forty-nine cases with stored videos of laparoscopic surgery using the Da Vinci system from 2015 to March 2021 were included. Peristalsis was defined by repeated contraction and expansion that was clearly visible three or more times in a row. The duodenum was investigated because it is frequently observed during gastrectomy. Suture failure was evaluated in cases with and without peristalsis. Results: The study population included 49 patients [male, n=32; female, n=17; median age, 71 (42-82) years]. Duodenal peristalsis was observed in 14 (28.6%) cases. Three patients experienced complications. A comparative study of cases with and without complications showed significant peristalsis in cases with complications (p=0.0198). Conclusion: A new definition to evaluate duodenal peristalsis was established. Anastomotic complications were significantly more frequent in cases with peristalsis (p=0.0198). Our results suggest the utility of manual over-sewing or the use of reinforcement material.Gastrectomy with lymphadenectomy is a standard treatment for gastric cancer. Even with advances in surgical techniques and perioperative management, anastomotic leakage remains a serious and potentially fatal complication of gastrectomy (1-3).According to a textbook, numerous factors cause or are associated with an increased risk of anastomotic leakage. These factors are classified into definitive and related factors. The definitive factors include technical aspects, the location on gastrointestinal tract, local factors, and bowel-related factors. The related factors include mechanical bowel preparation, drains, advanced malignancy, shock and coagulopathy, emergency surgery, blood transfusion, malnutrition, obesity, sex, smoking, steroid therapy, neoadjuvant therapy, deficiency of vitamin C, iron, zinc, and cysteine. Additionally, the related factors included stapler-related factors (i.e., forceful stapler extraction, tears caused by anvil or gun insertion, and failure of the stapler to close) (4). As noted above, forceful stapler extraction is a potential cause of anastomotic complications. We focused on duodenal peristalsis, which sometimes occurs, and hypothesized that it might cause forceful stapler extraction. We retrospectively investigated duodenal peristalsis. In our search of the relevant literature, we could not find any articles reporting a relationship between peristalsis and anastomotic complications.Laparoscopic surgery for gastric cancer is recorded. However, shaking of the video c...

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Section: Discussionmentioning

confidence: 94%

Does Intestinal Peristalsis Cause Suture Failure After Instrument Suture?

Rino

Aoyama

Maezawa

et al. 2023

In Vivo

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show abstract

“…In contrast, in a porcine model, the integrity of the mucosal staple lines was associated with the postoperative leak pressure on day 0. However, there was no association with the leak pressure from postoperative day two [17]. A lack of a statistically signi cant difference in the leak rate in laparoscopic sleeve gastrectomy with or without staple-line reinforcement was reported [18].…”

Section: Discussionmentioning

confidence: 94%

Does intestinal peristalsis cause suture failure after instrument suture?

Rino

Maezawa

Aoyama

et al. 2021

Preprint

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Introduction Gastrectomy with lymphadenectomy is a standard treatment for gastric cancer. Anastomotic leakage remains a potentially fatal complication of gastrectomy. Forceful stapler extraction may cause anastomotic complications. We focused on the duodenal peristalsis, as we hypothesized that it might cause forceful stapler extraction. We then retrospectively investigated duodenal peristalsis. We reviewed videos of Da Vinci system cases to clarify the relationship between peristalsis and anastomotic complications. Methods Forty-nine cases with stored videos of laparoscopic surgery using the Da Vinci system from 2015 to March 2021 were included. Peristalsis was defined by repeated contraction and expansion that was clearly visible three or more times in a row, and that there was no peristalsis in other cases. We investigated the duodenum because it is frequently observed during gastrectomy. We evaluated suture failure in cases with and without peristalsis. Results The study population included 49 patients (male, n=32; female, n=17; median age, 71 [42-82] years). Duodenal peristalsis was observed in 14 (28.6%) cases. Three patients experienced complications. A comparative study of cases with and without complications showed significant peristalsis in cases with complications (p=0.0198). Discussion Anastomotic leakage remains a serious and potentially fatal complication of gastrectomy, and surgeons should make efforts to prevent anastomotic leakage. Various risk factors associated with anastomotic leakage have been reported. This is the first retrospective study to evaluate duodenal peristalsis during gastrectomy for gastric cancer. We hypothesized that duodenal peristalsis would apply extreme tension on the stapler. Peristalsis would twist and increase the pressure on the stapler. In this study, we defined a new scale to evaluate duodenal peristalsis. Anastomotic complications were significantly more frequent in cases with peristalsis (p=0.0198). Our results suggest the utility of manual over-sewing or the use of reinforcement material.

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“…Intestinal anastomosis is a basic technique to restore gut continuity. Several intestinal anastomosis techniques, including hand-sewn, stapled, laparoscopic, robotic, and sutureless anastomoses, are used with varied outcomes (1)(2)(3)(4)(5)(6)(7)(8). The hand-sewn intestinal anastomosis technique is divided into single-layer and double-layer suture techniques (9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Asymmetric figure-of-eight single-layer suture technique for intestinal anastomosis: A preliminary study

Liu

Zhang²,

Ren³

et al. 2023

Front. Surg.

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BackgroundAnastomotic leakage is a life-threatening complication. Improvement of the anastomosis technique is needed, especially in patients with an inflamed edematous intestine. The aim of our study was to evaluate the safety and efficacy of an asymmetric figure-of-eight single-layer suture technique for intestinal anastomosis in pediatric patients.MethodsA total of 23 patients underwent intestinal anastomosis at the Department of Pediatric Surgery of Binzhou Medical University Hospital. Demographic characteristics, laboratory parameters, anastomosis time, duration of nasogastric tube placement, day of first postoperative bowel movement, complications, and length of hospital stay were statistically analyzed. The follow-up was conducted for 3–6 months after discharge.ResultsPatients were divided into two groups: the single-layer asymmetric figure-of-eight suture technique (group 1) and the traditional suture technique (group 2). Body mass index in group 1 was lower than in group 2 (14.43 ± 3.23 vs. 19.38 ± 6.74; P = 0.036). The mean intestine anastomosis time in group 1 (18.83 ± 0.83 min) was less than that in group 2 (22.70 ± 4.11 min; P = 0.005). Patients in group 1 had an earlier first postoperative bowel movement (2.17 ± 0.72 vs. 2.80 ± 0.42; P = 0.023). The duration of nasogastric tube placement in group 1 was shorter than that in group 2 (4.12 ± 1.42 vs. 5.60 ± 1.57; P = 0.043). There was no significant difference in laboratory variables, complication occurrence, and length of hospital stay between the two groups.ConclusionThe asymmetric figure-of-eight single-layer suture technique for intestinal anastomosis was feasible and effective. More studies are needed to compare the novel technique with the traditional single-layer suture.

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Intestinal mucosa staple line integrity and anastomotic leak pressure after healing in a porcine model

Cited by 4 publications

References 30 publications

Does Intestinal Peristalsis Cause Suture Failure After Instrument Suture?

Does Intestinal Peristalsis Cause Suture Failure After Instrument Suture?

Does intestinal peristalsis cause suture failure after instrument suture?

Asymmetric figure-of-eight single-layer suture technique for intestinal anastomosis: A preliminary study

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