Reinforcement Material on the Intestinal Stump Staple Line-The Effect and Mechanism of Reinforcement

Abstract

Background: In gastrointestinal surgery, the quality of anastomosis is one of the most important factors influencing the postoperative course. The purpose of this study was to verify the effectiveness and the mechanism of one type of reinforcement material. Methods: We analyzed the effect of NeoveilⓇ on the rate of staple line failure. Fresh pig small bowel was used. NeoveilⓇ sheets were placed on the anvil alone, cartridge alone or both sides of the stapler. Groups were: A, without NeoveilⓇ; B, the cartridge and anvil; C, the cartridge alone; D, the anvil alone. The burst pressures were measured. Results: In group A, a leak occurred at the intestinal stump in 5 of 10 cases (As). In the other 5 cases, the mesenteric side burst before failure of the staple line (Am). In groups B, C, and D, the mesenteric side burst before failure of the staple line. The median leak pressure was 100±46 mm Hg in group A (As; 57±6, Am; 143±12). In the other groups, the leak pressures were approximately 140 mm Hg. In group As, the middle staple only exists on the edge of stump. In group Am, however, both sides of the 3-row staple line exist on the edge of stump. Conclusion: The burst pressure of the stump became the result of the bipolarization. The strength of the stump staple line is affected by the arrangement of the staples. NeoveilⓇ was effective in obtaining a stronger staple line.