Comparison of pressure resistance of double-rows and triple-rows circular stapler in rectal double stapling technique: In vitro study

Background: Anastomotic leak after gastrointestinal anastomosis is a serious complication. Anastomotic failure depends on various parameters. The aim of our study was to evaluate the pressure resistance of a new device, EEA™ circular stapler with Tri-Staple™ technology 28 mm Medium/Thick (Triple-rows circular stapler; TCS) compared with EEA™ circular stapler with DST series™ technology 28 mm, 4.8 mm staples (double-rows circular stapler; DCS). Patients and methods: We performed 30 anastomoses (DSC: 15, TCS: 15) of DST with porcine colon model in vitro. We performed following 3 comparative experiences; Experiment 1: observation of staple shape with a colonoscopy, Experiment 2: comparison of the pressure resistance, Experiment 3: comparison of leakage points. Results: There was no hypoplasia of staples and the shapes were well-formed by colonoscopy. The leakage pressure of DCS was 19.6 ± 4.4 mm Hg (mean ± standard deviation) and that of TCS was 38.6 ± 10.2 mm Hg (mean ± standard deviation). There was a significantly difference between 2 groups (P < .001). 12 cases of DCS (80%) and 10 cases of TCS (66.7%) had leakages from Circular stapler point. 2 cases of DCS (13.3%) and 5 cases of TCS (33.3%) had leakages from Crossing points. Only 1 case of DCS had leakages from Dog ear point (6.7%). There was no significantly difference in leakage site between 2 groups (P = .195). Conclusions: TSC showed high pressure resistance during DST compared with that of DCS. It was suggested that TCS may contribute to the reduction of anastomotic leakage rate.

[1]  Y. Nagakawa,et al.  A Novel Predictive Model for Anastomotic Leakage in Colorectal Cancer Using Auto-artificial Intelligence , 2021, AntiCancer Research.

[2]  J. Fleshman,et al.  Perfusion Assessment in Left-Sided/Low Anterior Resection (PILLAR III): A Randomized, Controlled, Parallel, Multicenter Study Assessing Perfusion Outcomes With PINPOINT Near-Infrared Fluorescence Imaging in Low Anterior Resection , 2021, Diseases of the colon and rectum.

[3]  L. Boni,et al.  Intraoperative angiography with indocyanine green to assess anastomosis perfusion in patients undergoing laparoscopic colorectal resection: results of a multicenter randomized controlled trial , 2019, Surgical Endoscopy.

[4]  N. Kim,et al.  Anastomotic Leakage After Low Anterior Resection for Rectal Cancer Is Different Between Minimally Invasive Surgery and Open Surgery. , 2016, Annals of surgery.

[5]  Masaaki Ito,et al.  Effects of a diverting stoma on symptomatic anastomotic leakage after low anterior resection for rectal cancer: a propensity score matching analysis of 1,014 consecutive patients. , 2014, Journal of the American College of Surgeons.

[6]  M. Hashizume,et al.  Endoscopic evaluation of clinical colorectal anastomotic leakage. , 2015, The Journal of surgical research.

[7]  Masaaki Ito,et al.  Effectiveness of a Transanal Tube for the Prevention of Anastomotic Leakage after Rectal Cancer Surgery , 2014, World Journal of Surgery.

[8]  L. Shaffer,et al.  The effect of tissue compression on circular stapler line failure , 2011, Surgical Endoscopy.

[9]  Yong-Jun Zhang,et al.  Can Transanal Tube Placement after Anterior Resection for Rectal Carcinoma Reduce Anastomotic Leakage Rate? A Single-institution Prospective Randomized Study , 2011, World Journal of Surgery.

[10]  A. Mirnezami,et al.  Increased Local Recurrence and Reduced Survival From Colorectal Cancer Following Anastomotic Leak: Systematic Review and Meta-Analysis , 2011, Annals of surgery.

[11]  H. Putter,et al.  Multicentre analysis of oncological and survival outcomes following anastomotic leakage after rectal cancer surgery , 2009, The British journal of surgery.

[12]  W. Tan,et al.  Meta‐analysis of defunctioning stomas in low anterior resection for rectal cancer , 2009, The British journal of surgery.

[13]  Hao Wang,et al.  Influencing Factors of Symptomatic Anastomotic Leakage After Anterior Resection of the Rectum for Cancer , 2009, World Journal of Surgery.

[14]  C. Nigro,et al.  End‐to‐end versus end‐to‐side stapled anastomoses after anterior resection for rectal cancer , 2009, Journal of surgical oncology.

[15]  L. Påhlman,et al.  Risk factors for anastomotic leakage after rectal cancer surgery: a case‐control study , 2008, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.

[16]  P. Nardi,et al.  Prospective trial evaluating new circular and linear stapler devices for gastrointestinal anastomosis: preliminary data , 2008, Techniques in Coloproctology.

[17]  C. Yu,et al.  Risk Factors and Oncologic Impact of Anastomotic Leakage after Rectal Cancer Surgery , 2008, Diseases of the colon and rectum.

[18]  Masaaki Ito,et al.  Relationship between multiple numbers of stapler firings during rectal division and anastomotic leakage after laparoscopic rectal resection , 2008, International Journal of Colorectal Disease.

[19]  S. Msika,et al.  Anastomotic leakage after elective right versus left colectomy for cancer: prevalence and independent risk factors. , 2007, Journal of the American College of Surgeons.

[20]  R. Sjödahl,et al.  Defunctioning Stoma Reduces Symptomatic Anastomotic Leakage After Low Anterior Resection of the Rectum for Cancer: A Randomized Multicenter Trial , 2007, Annals of surgery.

[21]  T. Goto,et al.  Experimental evaluation of the mechanical strength of stapling techniques , 2007, Surgical Endoscopy.

[22]  S. Marecik,et al.  Single-stapled double-pursestring anastomosis after anterior resection of the rectum. , 2007, American journal of surgery.

[23]  W. Law,et al.  Leakage After Resection and Intraperitoneal Anastomosis for Colorectal Malignancy: Analysis of Risk Factors , 2006, Diseases of the colon and rectum.

[24]  E. Ram,et al.  Resting Anal Pressure Following Hemorrhoidectomy and Lateral Sphincterotomy , 2005, Diseases of the colon and rectum.

[25]  G. Branagan,et al.  Prognosis After Anastomotic Leakage in Colorectal Surgery , 2005, Diseases of the colon and rectum.

[26]  S. Shikora,et al.  A Comparison of Burst Pressure Between Buttressed Versus Non-Buttressed Staple-Lines in an Animal Model , 2005, Obesity surgery.

[27]  C. Marijnen,et al.  Risk factors for anastomotic failure after total mesorectal excision of rectal cancer , 2005, The British journal of surgery.

[28]  M. Bellomi,et al.  Double versus single stapling technique in rectal anastomosis , 1992, International Journal of Colorectal Disease.

[29]  James Foote,et al.  The Science of Stapling and Leaks , 2004, Obesity surgery.

[30]  B. Bittorf,et al.  Functional outcome after intersphincteric resection of the rectum with coloanal anastomosis in low rectal cancer. , 2004, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[31]  J. Marescaux,et al.  Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes , 2004, Surgical Endoscopy And Other Interventional Techniques.

[32]  J. Bruce,et al.  Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery , 2001, The British journal of surgery.

[33]  M. Talamini,et al.  Use of a cauterizing laparoscopic linear stapler in intestinal anastomosis. , 2000 .

[34]  R. Roumen,et al.  “Dog ear” formation after double-stapled low anterior resection as a risk factor for anastomotic disruption , 2000, Diseases of the colon and rectum.

[35]  W. Law,et al.  Risk factors for anastomotic leakage after low anterior resection with total mesorectal excision. , 2000, American journal of surgery.

[36]  J. Saric,et al.  Risk factors for anastomotic leakage after resection of rectal cancer , 1998, The British journal of surgery.

[37]  K. Miller,et al.  Circular stapling techniques for low anterior resection of rectal carcinoma. , 1996, Hepato-gastroenterology.

[38]  O. Goletti,et al.  Single and double stapled anastomoses in rectal cancer surgery; a retrospective study on the safety of the technique and its indication. , 1996, Acta chirurgica Belgica.

[39]  R. Heald,et al.  Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum , 1994, The British journal of surgery.

[40]  T. Hendriks,et al.  Healing of experimental intestinal anastomoses , 1990, Diseases of the colon and rectum.

[41]  J. Whitaker,et al.  The double stapling technique for low anterior resection. Results, modifications, and observations. , 1990, Annals of surgery.

[42]  D. Armstrong,et al.  The role of tissue ischemia in the pathogenesis of anastomotic stricture. , 1988, Surgery.

[43]  R. Chung,et al.  Blood flow in colonic anastomoses. Effect of stapling and suturing. , 1987, Annals of surgery.

[44]  D. Healy,et al.  Comparison of Automatic Staplers in Small Bowel Anastomoses , 1986, Southern medical journal.

[45]  Z. Cohen,et al.  Double stapling technique for low anterior resection , 1983, Diseases of the colon and rectum.

[46]  F. D. Griffen,et al.  An improved technique for low anterior resection of the rectum using the EEA stapler. , 1980, Surgery.