Profiling Surgical Staplers: Does Staple Direction Affect the Strength of the Anastomosis?

Abstract

Background: Few studies have been conducted regarding the optimal staple direction in gastrointestinal anastomosis. The purpose of this study was to evaluate the burst pressure of the anastomosis depending on the firing direction of the stapler. Methods: Pig esophagus and small bowel were used for all experiments. The small intestine represented a thin intestinal tract and the esophagus represented a thick intestinal tract. A side-to-side anastomosis was performed using a linear stapler, and the burst pressure was measured. A leak test on the anastomosis was then performed and burst pressures measured. Results: Burst pressures after anastomosis using a GIA™ 100-3.8 were 47.4 ± 10.4 mm Hg. With the same GIA, the burst pressure was significantly greater when the staples were driven from the small intestine into the esophagus (83.3 ± 17.3 mm Hg). Using the GIA™ 100-4.8, it was found that the burst pressure was significantly greater when the staplers were driven into the small intestine versus the esophagus (51.6 ± 7.1 vs. 68.6 ± 16.1 mm Hg). There was no significant difference between the different GIAs when fired in the same direction. Conclusion: Burst pressures were significantly greater when the staplers were driven from the small intestine into the esophagus. The direction of the staple line influences the strength of the anastomosis.

Does powered stapler improve the mechanical integrity of gastrojejunal anastomosis compared to the current techniques? Experimental study in ex vivo porcine models

“…described a similar experiment on porcine oesophagojejunostomy models using open surgical staplers. [ 22 ] The authors of this study had concluded that firing the surgical stapler from the thinner side, i.e., the small bowel, is better as it yielded higher BP on testing. This was in contradiction to our experiment where we demonstrated that firing the stapler from the gastric side, i.e., Group mLSA1, yielded higher BP when compared to Group mLSA2.…”

Compression injury of the circular stapler for gastrointestinal end-to-end anastomosis: preliminary in-vitro study

“…However, in the edematous collagen plates, the compressive pressure curve formed a gradual plateau even after further compression was applied beyond the optimal compression point. If there were presence of edema or inflammation in the colon, the tissue structure could be weakened and its density, elasticity, and restoration capability would have been deteriorated [ 15 ]. As a result, its structural integrity could be even further weakened by the accumulation of muscular and submucosal tears caused by overcompression [ 12 16 ].…”

Further Development of Magnetic Compression for Gastrojejunostomy in Rabbits

“…Notably, the burst pressures of anastomoses using magnets were greater than those using a staple line. 11 The extrusion time of the jejunal magnets or polythene tube device from the pylorus was determined according to the peristaltic activity and was also related to the shape and size of the object. Due to its complex structure, the polythene tube device was expelled later than the jejunal magnet.…”