Original articleStaple line reinforcement with new biomaterial increased burst strength pressure: an animal study
Section snippets
Methods
Forty animals (canine model developed at the University of São Paulo, São Paulo, Brazil) underwent general anesthesia. Two surgeons with experience with stapler devices performed all procedures. A midline laparotomy was performed in all animals, and a segment 20-cm distal to the ligament of Treitz was identified. A 45-mm linear stapler (EndoGIA, AutoSuture, U.S. Surgical, Norwalk, CT) with a blue cartridge (3.5-mm staple depth) was fired to divide the small intestine. The small bowel 10 cm
Results
We studied 40 staple line sutures created without Surgisis and 40 staple line sutures created with Surgisis. In three bowel segments with Surgisis, the rupture occurred through the bowel wall and not through the staple line. These data were excluded from the final statistical analysis.
The mean burst pressure was 209.26 ± 76.41 mm Hg of the stapler line without Surgisis and 441.33 ± 128.64 mm Hg with Surgisis. Fig. 2 shows the burst pressure results. The difference was statistically significant (
Discussion
The ideal method or material to prevent staple line complications should be easy to use and not increase the operative time; be biocompatible, behaving better during infection than other synthetic materials; increase tissue strength (assessed by burst strength experimental test), protecting the staple lines; not add to tissue thickness, preventing anastomotic occlusion; not result in stapler malfunction; and be cost effective.
A variety of methods have been used to prevent suture line failures,
Conclusion
The porcine small intestinal submucosa (Surgisis) membrane was able to significantly increase the burst strength pressures of the stapler line sutures. This material might help prevent suture line complications.
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7.39 Staple line reinforcement materials
2017, Comprehensive Biomaterials IITechnique or technology? Evaluating leaks after gastric bypass
2016, Surgery for Obesity and Related DiseasesCitation Excerpt :Given the collaborative nature of our consortium and our access to an expansive clinical registry, we had a unique opportunity to evaluate variation in technique as well as use of operative devices across a broad spectrum of surgical practices. It has been found in animal models that buttressed gastrointestinal staple lines maintain seam integrity at a significantly higher intraluminal pressure than nonbuttressed staple lines [17–19]. However, there has been no clear evidence to support that improvement in seam quality results in a decreased likelihood of experiencing a leak in gastric bypass surgery.
Comparative use of different techniques for leak and bleeding prevention during laparoscopic sleeve gastrectomy: A multicenter study
2014, Surgery for Obesity and Related DiseasesCitation Excerpt :However, standardization of SLR is still lacking due to the absence of a clear advantage of one method over the others. Several reports demonstrated specific SLR-related complications, including intraluminal migration of bovine pericardium strips, tissue ischemia, or sleeve stenosis after oversewing the staple line [19,20]. In a prospective, randomized trial, Dapri et al. reported no significant difference in leaks between SLR with Seamguard or oversewing compared with a no-SLR group [21].
Surgisis Fistula Plug: The United States Experience
2009, Seminars in Colon and Rectal SurgeryCitation Excerpt :Surgisis is manufactured into sheets of varying size and thickness and has been applied to a host of surgical indications. Hernia repair (inguinal, ventral, paraesophageal), urethral sling, and stapler line reinforcement with Surgisis are reported applications.28-31 The xenograft is resistant to infection, produces no giant cell foreign body reaction, and becomes repopulated with native host cell tissues within 12 weeks.32,33
Comparison of permanent and nonpermanent staple line buttressing materials for linear gastric staple lines during laparoscopic Roux-en-Y gastric bypass
2008, Surgery for Obesity and Related DiseasesCitation Excerpt :As with PSDV, it is considered remodelable. In 2 independent animal studies investigating burst pressure, both Pinheiro et al. [16] and Downey et al. [17] found that small intestinal staple lines buttressed with Surgisis could sustain significantly greater pressures before failing. To date, no human studies of this product have been published.
Profiling surgical staplers: effect of staple height, buttress, and overlap on staple line failure
2008, Surgery for Obesity and Related DiseasesCitation Excerpt :This observation is in agreement with several studies that have compared plain staple lines with reinforced ones. Animal studies have shown that reinforcement of the staple line with either bovine pericardium [16] or porcine small intestinal submucosa [17,18] increases the burst pressure of the staple lines in the bowel or stomach. However, buttressing can interfere with visualization and repeated staple fires.