Conquest of the Weak Point of the Side-to-side Anastomosis: The Novel Technique that Can Reinforce a Weak Point with Stapling

Abstract

Introduction: The improvement of stapling devices has been remarkable. As the stapler evolved from two lines to three lines of staples, the lateral strength of the anastomosis increased. However, the strength of the crotch did not change and the crotch remains the weak point of the side-to-side anastomosis. We previously reported the weakness of the crotch and the reinforcement method with animal model [1,2]. Technique: We describe our novel technique to reinforce the crotch using a physician-modified stapling device. A stapler with three rows of staples per side is arranged on a 6 cm segment using an EndoGIA Reinforce. Polymer felt is attached to both the cartridge fork and anvil fork of the stapler. The felt is then trimmed, as a length of 2 cm is sufficient for reinforcement of the crotch. Results: With this method, we can reinforce the weak point of the side-to-side anastomosis at the same time as the anastomosis. Conclusions: This method is a simple and novel technique to reinforce the crotch of a side-to-side anastomosis.