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

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.