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Experimental Evaluation of Staple Lines in Gastric Surgery

Experimental Evaluation of Staple Lines in Gastric Surgery Abstract • This study was designed to evaluate the bursting pressure, tensile strength, and healing of staple lines in the dog stomach. Pavlov pouches were created in 30 dogs using a single, double, or triple application of a stapler loaded with 4.8-mm staples. Staple lines were assessed immediately in half of the animals and after 21 days in the remaining animals. Acutely, reinforcing a single staple line with a second or third application of the stapler resulted in an anastomosis more resistant to leakage and disruption. Satisfactory healing occurred by 21 days and contributed to staple line strength in the pouches using a single and double application of the stapler. The orientation of collagen deposition in the anastomosis was related to the number of staples used. The degree of collagen deposition across the muscularis mucosa correlated with the healed staple line strength. Although healing occurred when a triple application of the stapler was utilized, the orientation of the fibroconnective tissue was parallel to the anastomosis and did not contribute to staple line integrity. (Arch Surg 1987;122:772-776) References 1. Ravitch MM, Steichen FM: Techniques of staple suturing the gastrointestinal tract . Ann Surg 1972;175:815-837.Crossref 2. Johnson DE, Fuerst DE: Use of auto suture for construction of ileal conduits . J Urol 1973;109:821-823. 3. McGinty CP, Kasten MC, Kinder JL, et al: Update on stapled bowel anastomosis . Mo Med 1979;76:145-150, 159. 4. Scott RN, Faraci RP, Hough A, et al: Bronchial stump closure techniques following penumonectomy: A serial comparative study . Ann Surg 1976;184:205-211.Crossref 5. Steichen FM: The creation of autologous substitute organs with stapling instruments . Am J Surg 1977;134:659-673.Crossref 6. Brolin RE, Ravitch MM: Studies in intestinal healing: VI. Effect of pharmacologically induced peristalsis on fresh intestinal anastomosis in dogs . Arch Surg 1980;115:339-343.Crossref 7. Eskind SJ, Massie JD, Born ML, et al: Experimental study of double staple lines in gastric partitions . Surg Gynecol Obstet 1981;152:751-756. 8. Ellison EC, Martin EW, Laschinger J, et al: Prevention of early failure of stapled gastric partitions in treatment of morbid obesity . Arch Surg 1980;115:528-533.Crossref 9. Scher KS, Scott-Conner C, Ong WT: A comparison of stapled and sutured anastomoses in gastric operations . Surg Gynecol Obstet 1982;154: 548-552. 10. Mason EE, Printen KJ, Barron P, et al: Risk reduction in gastric operations of obesity . Ann Surg 1979;190:158-165.Crossref 11. Smith L: Modifications of the gastric partitioning operation for morbid obesity . Am J Surg 1981;142:725-730.Crossref 12. Sugarman H: Gastroplasty for respiratory insufficiency of obesity . Ann Surg 1981;193:677-685.Crossref 13. Van Winkle W Jr, Hastings JC, Barker E, et al: Role of the fibroblast in controlling rate and extent of repair in wounds of various tissues , in Kulonen E, Pikkarainem J (eds): Biology of Fibroblast . Orlando, Fla, Academic Press Inc, 1973, pp 559-570. 14. Kulonen E: Reactivity of the connective tissues , in Kulonen E, Pikkarainem J (eds): Biology of Fibroblast . Orlando, Fla, Academic Press Inc, 1973, pp 3-7. 15. Elsdale T: The generation and maintenance of parallel arrays in cultures of diploid fibroblasts , in Kulonen E, Pikkarainem J (eds): Biology of Fibroblast . Orlando, Fla, Academic Press Inc, 1973, pp 41-58. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Experimental Evaluation of Staple Lines in Gastric Surgery

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Publisher
American Medical Association
Copyright
Copyright © 1987 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1987.01400190038007
Publisher site
See Article on Publisher Site

Abstract

Abstract • This study was designed to evaluate the bursting pressure, tensile strength, and healing of staple lines in the dog stomach. Pavlov pouches were created in 30 dogs using a single, double, or triple application of a stapler loaded with 4.8-mm staples. Staple lines were assessed immediately in half of the animals and after 21 days in the remaining animals. Acutely, reinforcing a single staple line with a second or third application of the stapler resulted in an anastomosis more resistant to leakage and disruption. Satisfactory healing occurred by 21 days and contributed to staple line strength in the pouches using a single and double application of the stapler. The orientation of collagen deposition in the anastomosis was related to the number of staples used. The degree of collagen deposition across the muscularis mucosa correlated with the healed staple line strength. Although healing occurred when a triple application of the stapler was utilized, the orientation of the fibroconnective tissue was parallel to the anastomosis and did not contribute to staple line integrity. (Arch Surg 1987;122:772-776) References 1. Ravitch MM, Steichen FM: Techniques of staple suturing the gastrointestinal tract . Ann Surg 1972;175:815-837.Crossref 2. Johnson DE, Fuerst DE: Use of auto suture for construction of ileal conduits . J Urol 1973;109:821-823. 3. McGinty CP, Kasten MC, Kinder JL, et al: Update on stapled bowel anastomosis . Mo Med 1979;76:145-150, 159. 4. Scott RN, Faraci RP, Hough A, et al: Bronchial stump closure techniques following penumonectomy: A serial comparative study . Ann Surg 1976;184:205-211.Crossref 5. Steichen FM: The creation of autologous substitute organs with stapling instruments . Am J Surg 1977;134:659-673.Crossref 6. Brolin RE, Ravitch MM: Studies in intestinal healing: VI. Effect of pharmacologically induced peristalsis on fresh intestinal anastomosis in dogs . Arch Surg 1980;115:339-343.Crossref 7. Eskind SJ, Massie JD, Born ML, et al: Experimental study of double staple lines in gastric partitions . Surg Gynecol Obstet 1981;152:751-756. 8. Ellison EC, Martin EW, Laschinger J, et al: Prevention of early failure of stapled gastric partitions in treatment of morbid obesity . Arch Surg 1980;115:528-533.Crossref 9. Scher KS, Scott-Conner C, Ong WT: A comparison of stapled and sutured anastomoses in gastric operations . Surg Gynecol Obstet 1982;154: 548-552. 10. Mason EE, Printen KJ, Barron P, et al: Risk reduction in gastric operations of obesity . Ann Surg 1979;190:158-165.Crossref 11. Smith L: Modifications of the gastric partitioning operation for morbid obesity . Am J Surg 1981;142:725-730.Crossref 12. Sugarman H: Gastroplasty for respiratory insufficiency of obesity . Ann Surg 1981;193:677-685.Crossref 13. Van Winkle W Jr, Hastings JC, Barker E, et al: Role of the fibroblast in controlling rate and extent of repair in wounds of various tissues , in Kulonen E, Pikkarainem J (eds): Biology of Fibroblast . Orlando, Fla, Academic Press Inc, 1973, pp 559-570. 14. Kulonen E: Reactivity of the connective tissues , in Kulonen E, Pikkarainem J (eds): Biology of Fibroblast . Orlando, Fla, Academic Press Inc, 1973, pp 3-7. 15. Elsdale T: The generation and maintenance of parallel arrays in cultures of diploid fibroblasts , in Kulonen E, Pikkarainem J (eds): Biology of Fibroblast . Orlando, Fla, Academic Press Inc, 1973, pp 41-58.

Journal

Archives of SurgeryAmerican Medical Association

Published: Jul 1, 1987

References