Original articleProfiling surgical staplers: effect of staple height, buttress, and overlap on staple line failure
Section snippets
Methods
The study included three separate experiments aimed at assessing the effect of different variables on the leak pressure of a staple line: (1) staple height and buttressing of the staple line, (2) the presence of overlapping staples in the staple line, and (3) buttressing of overlapping staple lines.
Experiment 1: staple height and buttressing of staple line
The effect of the staple height and buttressing was assessed by creating 48 staple lines (leak pressure, median 69.1 mm Hg, range 1.9–280). Bursting of the bowel before the staple line leak occurred in 6 cases (2 blue loads with buttressing, 1 white load without buttressing, and 3 white loads with buttressing).
The leak pressure was significantly related to the type of staple load (Table 1). Overall, green staple loads had the lowest leak pressure (median 35.5 mm Hg, range 1.9–104.6) compared
Discussion
Surgical stapling instruments are being increasingly used for gastrointestinal anastomoses. Although it is recognized that stapled anastomoses are faster to create and lead to outcomes similar to those with hand-sewn anastomoses [12], [13], [14], the best technique and stapler profile to use remains unclear. It is also difficult to generalize the finding of these studies to other clinical scenarios. For example, it might be difficult to apply the results from a study of intestinal anastomoses
Conclusion
The variability in leak pressures among the different applications of the same stapler is great. Staple height is an important determinant of leak pressure. In our study, the presence of an overlap did not affect leak pressure. In fact, a trend toward improvement was seen with overlapping staple lines. Buttressing improves the leak pressure for all types of staple lines. Future studies are warranted to better define the ideal stapler to use for different clinical scenarios.
Disclosures
The authors have no commercial associations that might be a conflict of interest in relation to this article.
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