Automatic surgical staples are associated with significant decrease of surgical time and complication rate after gastrointestinal surgery.Leakage still occur in 11% of cases after intestinal surgery1-2. Staple size, conformation and incorporation of the holding layer are crucial factors to maintain a seal while allowing local vascular perfusion.There are no studies demonstrating the efficacy of different staple sizes for partial gastrectomies.We proposed a canine cadaveric study to compare the efficacy on a partial gastrectomy model.
Eight fresh canine stomachs were harvested. Tissue thickness was measured at the fundus, body and pyloric antrum.Each stomach was transected across their body to standardize gastric thickness.The proximal and distal sections were randomized in two groups; GB received blue staples (3.5mm) and GG received green staples (4.8mm) to seal the gastric body with an automatic linear stapler. Bursting pressures were recorded with a pressure transducer. Gastric layer incorporation and staple conformation were visualized and assessed with fluoroscopy. Mean (+/-SD) bursting pressures from GG were statistically significantly lower (GB;55.23+/-18.1mmHg,GG;21.33+/-3.7mmHg,p=0.0001). Mean (+/-SD) stomach body thickness was 7.19+/-2mm. All layers were incorporated on the staple lines from both groups. Staple conformation for GG was significantly superior compared to GB. Although blue staples supported higher pressures, green staples may be sufficient to prevent gastric leakage and maintain the blood supply at the gastrectomy site. Clinical studies are necessary to evaluate regional perfusion and gastric healing after automatic staple gastrectomy.
1. Duell JR, Thieman Mankin KM, et al. Frequency of Dehiscence in Hand-Sutured and Stapled Intestinal Anastomoses in Dogs. Vet Surg. 2016;45(1):100-3.
2. Baker RS, Foote J, Kemmeter P, et al. The science of stapling and leaks. Obes Surg 2004;14:1290– 1298.