Intestinal resection and anastomosis is frequently performed in small animal surgery to remove devitalized or diseased segments of bowel. Various successful anastomosis techniques involving suture or metal staples have been described.1–4 The choice of technique is often related to surgeon preference; however, stapled anastomoses can be performed more quickly and thus are often chosen in emergency situations.2,5–7 Stapled anastomosis techniques include side-to-side (FEESA), circular end to end (end-to-end anastomosis), and triangulating end to end (everting end-to-end anastomosis) as well as inverting end-to-end anastomosis with an end-to-end anastomosis stapler and end-to-end anastomosis with a disposable skin stapler.2,7–10 The most widely accepted and performed stapled anastomosis is FEESA, which involves use of a gastrointestinal anastomosis stapler to form a side-to-side intestinal connection, with the terminal ends closed by use of a thoracoabdominal or gastrointestinal anastomosis stapling device.1,3,7,11,12 The gastrointestinal anastomosis staple technique is advantageous because of the rapidity of application and quality of residual luminal diameter, but it requires the use of potentially expensive mechanical stapling instruments and supplies (15 to 25 times as much as the cost of a suture anastomosis, depending on the supplier and type of equipment [disposable vs multiuse equipment]). In the authors’ experience, use of FEESA has resulted in failure of the closure at the terminal end of the intestinal staple line. The veterinary and human literature does not specifically address the influence of staple line positioning in anastomosis failures, and conflicting conclusions have been reached regarding stapling technique, blood flow, and anastomosis failure.3–6,8,11,13–18 Staple position, staple intersection, and staple method may be mechanical factors that influence performance of FEESA constructs.
The purpose of the study reported here was to evaluate leakage pressure, leakage location, and MIP for FEESA constructs and to compare results with those reported for other studies19,20 conducted to evaluate sutured anastomoses tested by use of the same methods. Our primary hypothesis was that stapled anastomoses would have leakage and MIP values similar to those reported19,20 for sutured anastomoses regardless of the configuration of the gastrointestinal anastomosis staple line used for closure of the terminal end. Our secondary hypothesis was that there would be no difference in leakage location between the thoracoabdominal and gastrointestinal anastomosis staple lines.
The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Army, the Department of Defense, the US Government, or Covidien Animal Health.
Complete gastrointestinal anastomosis staple line offset
Functional end-to-end stapled anastomosis
Maximum intraluminal pressure
No gastrointestinal anastomosis staple line offset
Partial gastrointestinal anastomosis staple line offset
Beuthanasia-D Special, Intervet Inc, Merck Animal Health, Summit, NJ.
GIA 50 multiuse stapling device, Tyco, United States Surgical, Norwalk, Conn.
AutoSuture GIA 50 Premium, 3.8 mm, Tyco, United States Surgical, Norwalk, Conn.
TA 55 multiuse stapling device, Tyco, United States Surgical, Norwalk, Conn.
AutoSuture TA Premium, 3.5 mm, Tyco, United States Surgical, Norwalk, Conn.
Biosyn, 4-0 USP, provided by Covidien Animal Health, Mansfield, Mass.
FR 4, Boston Scientific Corp, Marlborough, Mass.
Mikro-Tip catheter transducer, Millar Instruments Inc, Houston, Tex.
SonoLab, Sonometrics Corp, London, ON, Canada.
Fisher Scientific, Pittsburgh, Pa.
Harvard Apparatus, Holliston, Mass.
JMP, version 11, SAS Institute Inc, Cary, NC.
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