A comparison of burst pressure between buttressed versus non-buttressed staple-lines in an animal model.
BACKGROUND
The consequences of a staple-line leak or disruption can be devastating particularly in the bariatric surgery population. This study was designed to assess if gastrointestinal staple-lines buttressed with bovine pericardium could tolerate greater intraluminal pressures compared with non-reinforced staple-lines.


METHODS
A laparoscopic linear cutting staple device was used to create divided staple-lines across the small intestine in a porcine model and the stomach in a rabbit model. 21 staple-lines were created with buttressing strips of bovine pericardium, and another 21 staple-lines were created without any reinforcement. All staple-lines were subjected to a constant rate increase in intraluminal pressure via intraluminal infusion of a dye solution. At the first sign of seam leak or failure, the burst pressure was recorded.


RESULTS
In 19 of the 21 studies, the staple-lines buttressed with bovine pericardium sustained higher mean burst pressures than the conventional non-buttressed staple-lines. For the porcine intestinal segments, the mean intraluminal pressure at failure was 125 +/- 24 mmHg for buttressed staple-lines versus 58.4 +/- 28 mm Hg for conventional staple-lines (P <0.0001). For rabbit stomach segments, the mean intraluminal pressure at failure was also significantly higher for the buttressed segments (115 +/- 24 vs 75.6 +/- 23, P <0.0137). Most buttressed segments failed away from the staple-line, while the non-buttressed segments failed at the staple-line.


CONCLUSIONS
Gastrointestinal staple-lines buttressed with bovine pericardium are able to maintain seam integrity at significantly higher intraluminal pressures when compared to non-buttressed GI staple-lines in animal models.
Arnold
William
W
Center for Minimally Invasive Obesity Surgery, Department of Surgery, Tufts-New England Medical Center, Boston, MA 02111, USA.
Shikora
Scott A
SA
D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D000818:Animals; D002417:Cattle; D019245:Compressive Strength; D004195:Disease Models, Animal; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D010496:Pericardium / Q000637:transplantation; D011183:Postoperative Complications / Q000517:prevention & control; D011312:Pressure; D011817:Rabbits; D012680:Sensitivity and Specificity; D013528:Surgical Staplers; D017792:Surgical Stapling / Q000009:adverse effects / Q000379:methods*; D013552:Swine