Is staple line reinforcement still needed on contemporary staplers? A benchtop analysis,Surgical Endoscopy

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Is staple line reinforcement still needed on contemporary staplers? A benchtop analysis
Surgical Endoscopy ( IF 2.4 ) Pub Date : 2022-09-29 , DOI: 10.1007/s00464-022-09644-6
Bipan Chand ₁ , Christen Meyers ₁

Affiliation

Background

Staple line reinforcement (SLR) is commonly used in bariatric surgeries to reduce leaks and bleeds. With the evolution of staplers, the need for buttressing with the latest surgical stapling technology is in question. The efficacy of GORE® SEAMGUARD® (G-SLR) to improve staple line strength based on an established measure of burst pressure was evaluated. A benchtop test on synthetic tissue evaluated the pressure required for staple line leak across surgical staplers with and without G-SLR.

Methods

Staple lines on a consistent thickness synthetic bowel were pressurized to the point of failure (burst pressure) among Ethicon®, Intuitive®, and Medtronic® surgical staplers with and without G-SLR. Burst pressure and leak location (through the staple line [TTSL] or through the staple [TTS], on the anvil or cartridge side) were recorded. Visual confirmation of a leak concluded each test.

Results

The pooled mean burst pressure for G-SLR was greater (p < 0.05) by 0.494 pounds/square inch compared with no reinforcement with no meaningful differences among staplers. Leak failures were primarily TTS (91.7%) and equally distributed between reinforcement groups with more leak failures on the cartridge side with G-SLR and on the anvil side for non-SLR group. Leaks occurred across the length of staple lines with no discernable pattern.

Conclusion

Employing a buttressing material strengthens the staple line, as measured by burst pressure, and may reduce the risk for staple line failure. This benchtop study of G-SLR with three commonly used surgical staplers demonstrated a significant increase in burst pressures among the studied stapling devices.

Graphical abstract

中文翻译：

现代订书机还需要订书钉线加固吗？台式分析

背景

钉线加固 (SLR) 通常用于减肥手术，以减少渗漏和出血。随着吻合器的发展，是否需要用最新的外科吻合技术进行支撑成为问题。GORE® SEAMGUARD® (G-SLR) 根据既定的爆破压力测量值提高订书钉线强度的功效得到评估。对合成组织进行的台式测试评估了带和不带 G-SLR 的手术缝合器缝合线泄漏所需的压力。

方法

在带有和不带有 G-SLR 的 Ethicon®、Intuitive® 和 Medtronic® 外科缝合器中，厚度一致的合成肠管上的吻合线被加压到失效点（爆破压力）。记录爆破压力和泄漏位置（通过订书钉线 [TTSL] 或通过订书钉 [TTS]，在砧座或钉仓侧）。目视确认泄漏结束了每个测试。

结果

与无加固相比，G-SLR 的合并平均爆破压力更大 ( p < 0.05) 0.494 磅/平方英寸，订书机之间没有显着差异。泄漏故障主要是 TTS (91.7%)，并且在加固组之间平均分布，G-SLR 的滤筒侧和非 SLR 组的砧座侧有更多泄漏故障。泄漏发生在订书钉线的长度上，没有可辨别的图案。