William Arnold1, Scott A Shikora. 1. Center for Minimally Invasive Obesity Surgery, Department of Surgery, Tufts-New England Medical Center, Boston, MA 02111, USA.
Abstract
BACKGROUND: The consequences of a staple-line leak or disruption can be devastating particularly in the bariatric surgery population. This study was designed to assess if gastrointestinal staple-lines buttressed with bovine pericardium could tolerate greater intraluminal pressures compared with non-reinforced staple-lines. METHODS: A laparoscopic linear cutting staple device was used to create divided staple-lines across the small intestine in a porcine model and the stomach in a rabbit model. 21 staple-lines were created with buttressing strips of bovine pericardium, and another 21 staple-lines were created without any reinforcement. All staple-lines were subjected to a constant rate increase in intraluminal pressure via intraluminal infusion of a dye solution. At the first sign of seam leak or failure, the burst pressure was recorded. RESULTS: In 19 of the 21 studies, the staple-lines buttressed with bovine pericardium sustained higher mean burst pressures than the conventional non-buttressed staple-lines. For the porcine intestinal segments, the mean intraluminal pressure at failure was 125 +/- 24 mmHg for buttressed staple-lines versus 58.4 +/- 28 mm Hg for conventional staple-lines (P <0.0001). For rabbit stomach segments, the mean intraluminal pressure at failure was also significantly higher for the buttressed segments (115 +/- 24 vs 75.6 +/- 23, P <0.0137). Most buttressed segments failed away from the staple-line, while the non-buttressed segments failed at the staple-line. CONCLUSIONS: Gastrointestinal staple-lines buttressed with bovine pericardium are able to maintain seam integrity at significantly higher intraluminal pressures when compared to non-buttressed GI staple-lines in animal models.
BACKGROUND: The consequences of a staple-line leak or disruption can be devastating particularly in the bariatric surgery population. This study was designed to assess if gastrointestinal staple-lines buttressed with bovine pericardium could tolerate greater intraluminal pressures compared with non-reinforced staple-lines. METHODS: A laparoscopic linear cutting staple device was used to create divided staple-lines across the small intestine in a porcine model and the stomach in a rabbit model. 21 staple-lines were created with buttressing strips of bovine pericardium, and another 21 staple-lines were created without any reinforcement. All staple-lines were subjected to a constant rate increase in intraluminal pressure via intraluminal infusion of a dye solution. At the first sign of seam leak or failure, the burst pressure was recorded. RESULTS: In 19 of the 21 studies, the staple-lines buttressed with bovine pericardium sustained higher mean burst pressures than the conventional non-buttressed staple-lines. For the porcine intestinal segments, the mean intraluminal pressure at failure was 125 +/- 24 mmHg for buttressed staple-lines versus 58.4 +/- 28 mm Hg for conventional staple-lines (P <0.0001). For rabbit stomach segments, the mean intraluminal pressure at failure was also significantly higher for the buttressed segments (115 +/- 24 vs 75.6 +/- 23, P <0.0137). Most buttressed segments failed away from the staple-line, while the non-buttressed segments failed at the staple-line. CONCLUSIONS: Gastrointestinal staple-lines buttressed with bovine pericardium are able to maintain seam integrity at significantly higher intraluminal pressures when compared to non-buttressed GI staple-lines in animal models.
Authors: George A Giannopoulos; Nikolaos E Tzanakis; George E Rallis; Stamatis P Efstathiou; Christos Tsigris; Nikolaos I Nikiteas Journal: Surg Endosc Date: 2010-04-16 Impact factor: 4.584
Authors: T Goto; K Kawasaki; Y Fujino; K Kanemitsu; T Kamigaki; D Kuroda; Y Suzuki; Y Kuroda Journal: Surg Endosc Date: 2007-02-07 Impact factor: 4.584