Skip to main content
main-content

Tipp

Weitere Artikel dieser Ausgabe durch Wischen aufrufen

Erschienen in: European Surgery 1/2019

29.11.2018 | original article

Validation of the vulnerable crotch on a side-to-side anastomosis: Observation of the burst process

verfasst von: MD, PhD Masahiro Kimura, MD, PhD Satoshi Taniwaki, MD, PhD Yasuyuki Shibata, MD, PhD Nobuo Ochi, MD, PhD Takaya Nagasaki, MD Shuhei Ueno, MD Yuki Eguchi, MD Hiroyuki Asai

Erschienen in: European Surgery | Ausgabe 1/2019

Einloggen, um Zugang zu erhalten
share
TEILEN

Summary

Background

The vulnerability of the crotch on a side-to-side anastomosis to leak has been widely recognized. However, countermeasures to prevent leaks from the crotch have not proven to be sufficient.

Methods

A side-to-side anastomosis was performed between two intestinal specimens using a linear stapler. We analyzed the burst pressures of anastomoses. Comparison was made in five groups, with different staple heights, presence of Neoveil® (Gunze, Japan), with or without crotch buttressed with nylon. Using an endoscope inserted into the intestinal lumen, we observed the burst process.

Results

We observed a significant difference in the resistance of the crotch to leak between the two types of reinforcement. In all experimental groups, the leak was observed not only on the serosal surface but also from within the lumen. Neoveil® significantly increased the burst pressure (41.4 ± 3.6 vs. 88.8 ± 14.6 mm Hg; p < 0.01). When reinforced with nylon suture, resistance to leak was recognized only in anastomoses with suture reinforcement from within the lumen. Observing from within the intestinal lumen, as the pressure increased, the intestine split along the length of the stapled anastomosis. A leak occurred when the split reached the center of the staple line. In the group using Neoveil® there was no obvious change in the Neoveil® itself with increases in pressure. In the group reinforced with nylon sutures, the crotch of the anastomosis expanded, and the intestine split, leading to a dehiscence and leak.

Conclusions

The efficacy of various crotch reinforcement methods both experimentally and clinically has thus far been in doubt. With our experiment, the mechanism by which leaks occur at the crotch has become clear, giving evidence for the optimal reinforcement method for stapled intestinal anastomoses.
Literatur
1.
Zurück zum Zitat Gong CS, Kim BS, Kim HS. Comparison of totally laparoscopic total gastrectomy using an endoscopic linear stapler with laparoscopic-assisted total gastrectomy using a circular stapler in patients with gastric cancer: a single-center experience. World J Gastroenterol. 2017;28:8553–61. CrossRef Gong CS, Kim BS, Kim HS. Comparison of totally laparoscopic total gastrectomy using an endoscopic linear stapler with laparoscopic-assisted total gastrectomy using a circular stapler in patients with gastric cancer: a single-center experience. World J Gastroenterol. 2017;28:8553–61. CrossRef
2.
Zurück zum Zitat Giaccaglia V, Antonelli MS, Franceschilli L, et al. Different characteristics of circular staplers make the different in anastomotic tensile strength. J Mech Behav Biomed Mater. 2016;53:295–300. CrossRef Giaccaglia V, Antonelli MS, Franceschilli L, et al. Different characteristics of circular staplers make the different in anastomotic tensile strength. J Mech Behav Biomed Mater. 2016;53:295–300. CrossRef
3.
Zurück zum Zitat Kimura M, Takahashi H, Tanaka T, et al. Weak points of a stapled side-to-side anastomosis. Hepatogastroenterology. 2015;62(140):924–6. PubMed Kimura M, Takahashi H, Tanaka T, et al. Weak points of a stapled side-to-side anastomosis. Hepatogastroenterology. 2015;62(140):924–6. PubMed
4.
Zurück zum Zitat Kimura M, Kuwabara Y, Taniwaki S, et al. Improved the side-to-side stapled anastomosis: comparison of staples for robust crotch formation. Surg Obes Relat Dis. 2018;14:16–22. CrossRef Kimura M, Kuwabara Y, Taniwaki S, et al. Improved the side-to-side stapled anastomosis: comparison of staples for robust crotch formation. Surg Obes Relat Dis. 2018;14:16–22. CrossRef
5.
Zurück zum Zitat Kitagami H, Morimoto M, Nakamura K, et al. Technique of Roux-en-Y reconstruction using overlap method after laparoscopic total gastrectomy for gastric cancer: 100 consecutively successful cases. Surg Endosc. 2016;30(9):4086–91. CrossRef Kitagami H, Morimoto M, Nakamura K, et al. Technique of Roux-en-Y reconstruction using overlap method after laparoscopic total gastrectomy for gastric cancer: 100 consecutively successful cases. Surg Endosc. 2016;30(9):4086–91. CrossRef
6.
Zurück zum Zitat Champion JK, Williams M. Prospectve randomized trial of prospective randomized trial of heated humidified versus cold dry carbon dioxide insufflation during laparoscopic gastric bypass. Surg Obes Relat Dis. 2006;2(4):445–9. CrossRef Champion JK, Williams M. Prospectve randomized trial of prospective randomized trial of heated humidified versus cold dry carbon dioxide insufflation during laparoscopic gastric bypass. Surg Obes Relat Dis. 2006;2(4):445–9. CrossRef
7.
Zurück zum Zitat Nandakumar G, Richards BG, Trencheva K, et al. Surgical adhesive increases burst pressure and seals leaks in stapled gastrojejunostomy. Surg Obes Relat Dis. 2010;6(5):498–501. CrossRef Nandakumar G, Richards BG, Trencheva K, et al. Surgical adhesive increases burst pressure and seals leaks in stapled gastrojejunostomy. Surg Obes Relat Dis. 2010;6(5):498–501. CrossRef
8.
Zurück zum Zitat Miller KA, Pump A. Use of boabsorbable staple reinforcement material in gastric bypass: a prospective randomized clinical trial. Surg Obes Relat Dis. 2007;3:417–22. CrossRef Miller KA, Pump A. Use of boabsorbable staple reinforcement material in gastric bypass: a prospective randomized clinical trial. Surg Obes Relat Dis. 2007;3:417–22. CrossRef
9.
Zurück zum Zitat Esquivel CM, Ampudia C, Fridman A, et al. Technique and outcomes of laparoscopic-combined linear stapler and hand-sutured side-to-side esophagojejunostomy with Roux-en-Y reconstruction as a treatment modality in patients undergoing proximal gastrectomy for benign and malignant disease of the gastroesophageal junction. Surg Laparosc Endosc Percutan Tech. 2014;24(1):89–93. CrossRef Esquivel CM, Ampudia C, Fridman A, et al. Technique and outcomes of laparoscopic-combined linear stapler and hand-sutured side-to-side esophagojejunostomy with Roux-en-Y reconstruction as a treatment modality in patients undergoing proximal gastrectomy for benign and malignant disease of the gastroesophageal junction. Surg Laparosc Endosc Percutan Tech. 2014;24(1):89–93. CrossRef
10.
Zurück zum Zitat Man-i M, Suda K, Kikuchi K, et al. Totally intracorporeal delta-shaped B‑I anastomosis following laparoscopic distal gastrectomy using the Tri-Staple™ reloads on the manual ultra handle: a prospective cohort study with historical controls. Surg Endosc. 2015;29(11):3304–12. CrossRef Man-i M, Suda K, Kikuchi K, et al. Totally intracorporeal delta-shaped B‑I anastomosis following laparoscopic distal gastrectomy using the Tri-Staple™ reloads on the manual ultra handle: a prospective cohort study with historical controls. Surg Endosc. 2015;29(11):3304–12. CrossRef
11.
Zurück zum Zitat Kimura M, Terashita Y. Use of bioabsorbable staple reinforcement material in side-to-side anastomoses: suture line reinforcement of the weak point of the anastomosis. Ann Med Surg (Lond). 2016;6:50–5. CrossRef Kimura M, Terashita Y. Use of bioabsorbable staple reinforcement material in side-to-side anastomoses: suture line reinforcement of the weak point of the anastomosis. Ann Med Surg (Lond). 2016;6:50–5. CrossRef
12.
Zurück zum Zitat Kawai N, Kawaguchi T, Suzuki S, et al. Low-voltage coagulation, polyglycolic acid sheets, and fibrin glue to control air leaks in lung surgery. Gen Thorac Cardiovasc Surg. 2017;65(12):705–9. CrossRef Kawai N, Kawaguchi T, Suzuki S, et al. Low-voltage coagulation, polyglycolic acid sheets, and fibrin glue to control air leaks in lung surgery. Gen Thorac Cardiovasc Surg. 2017;65(12):705–9. CrossRef
13.
Zurück zum Zitat Shi Z, Xu Y, Wang Z, et al. One successful primary closure case of bronchopleural fistula after pneumonectomy by a new method. J Thorac Dis. 2017;9(4):E358–E63. CrossRef Shi Z, Xu Y, Wang Z, et al. One successful primary closure case of bronchopleural fistula after pneumonectomy by a new method. J Thorac Dis. 2017;9(4):E358–E63. CrossRef
14.
Zurück zum Zitat Saito T, Kaneda H, Konobu T, et al. The covering with forceps-assisted polymeric biodegradable sheet and endostapling method: a simplified technique for wide coverage and reinforcement of staple-line in video-assisted thoracoscopic bullectomy for spontaneous pneumothorax. Interact Cardiovasc Thorac Surg. 2011;12(2):103–5. CrossRef Saito T, Kaneda H, Konobu T, et al. The covering with forceps-assisted polymeric biodegradable sheet and endostapling method: a simplified technique for wide coverage and reinforcement of staple-line in video-assisted thoracoscopic bullectomy for spontaneous pneumothorax. Interact Cardiovasc Thorac Surg. 2011;12(2):103–5. CrossRef
15.
Zurück zum Zitat Goto T, Kawasaki Y, Fujino Y, et al. Evaluation of the mechanical strength and patency of functional end-to-end anastomoses. Surg Endosc. 2007;21:1508–11. CrossRef Goto T, Kawasaki Y, Fujino Y, et al. Evaluation of the mechanical strength and patency of functional end-to-end anastomoses. Surg Endosc. 2007;21:1508–11. CrossRef
Metadaten
Titel
Validation of the vulnerable crotch on a side-to-side anastomosis: Observation of the burst process
verfasst von
MD, PhD Masahiro Kimura
MD, PhD Satoshi Taniwaki
MD, PhD Yasuyuki Shibata
MD, PhD Nobuo Ochi
MD, PhD Takaya Nagasaki
MD Shuhei Ueno
MD Yuki Eguchi
MD Hiroyuki Asai
Publikationsdatum
29.11.2018
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 1/2019
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-018-0561-x