An update of available innovative staple line reinforcement materials in colorectal surgery.

Despite refinements in the field of gastrointestinal surgical stapling, anastomotic leakage and bleeding still remain a serious problem associated with substantial morbidity and mortality. To prevent or reduce these complications, a diversity of staple line reinforcement techniques have been developed. The available literature from 1977 through 2007 was reviewed to find relevant data about innovative colorectal staple line reinforcement techniques. Many different forms of staple line reinforcement are available. Reinforcement methods can be material applied exogenously to the staple line or incorporated into the staple line. Reinforcement materials can be nonabsorbable, semi-absorbable, or fully absorbable. Gastrointestinal staple line reinforcement is well known, but it is a relatively new method for colorectal surgery. Staple line reinforcement is an effective technique in reducing complications in stapled anastomoses only if proper buttressing material is used. Absorbable material seems to have several advantages over non- or semi-absorbable staple line reinforcement. New and promising techniques are fibrin glue, C-seal, and biosynthesized absorbable cellulose used as staple line reinforcement material. Unfortunately, there is not much experience reported with these new materials, thus further investigation is needed.