title: Experimental evaluation of the mechanical strength of stapling techniques.
abstract: BACKGROUND
  The single stapling technique (SST) and the double stapling technique (DST) are common anastomoses for rectal cancer. Although many mechanical devices have been developed, the best choice remains unclear. In this study we examined the strength of anastomoses by determining their bursting pressures using an animal model.
  
  
  METHODS
  The intestines of pigs were used. In experiment 1, we compared the bursting pressures for Endo GIA 60 blue, Endo GIA 60 green, and GIA 60 blue. In experiment 2, the bursting pressures of a buttressed cutting site and a nonbuttressed cutting site were measured. In experiment 3, the SST, DST, and DST with buttress using PCEEA were performed and the bursting pressures and points of these anastomoses were examined.
  
  
  RESULTS
  The bursting pressure of Endo GIA 60 blue (80.3 +/- 10.5 mmHg) was significantly higher than that of Endo GIA 60 green (37.3 +/- 4.2 mmHg) and GIA 60 blue (31.7 +/- 5.8 mmHg) (p < 0.01). When a cut end was buttressed, the bursting pressure (149.6 +/- 37.6 mmHg) was significantly higher than that of the nonbuttressed end (75.3 +/- 25.1 mmHg) (p < 0.01). The bursting pressure among SST, DST, and DST with buttress was not significantly different. Only one bursting point was the crossing point of the PCEEA and Endo GIA and the bursting pressure of this point was much lower than that of the others.
  
  
  CONCLUSIONS
  Endo GIA was most suitable for DST. The SST, DST, and DST with buttress had almost the same strength. The crossing point of PCEEA and Endo GIA may be a dangerous point for DST.
authors.affiliation: Division of Gastroenterological Surgery, Department of Clinical Molecular Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan. kawaken@med.kobe-u.ac.jp
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kawasaki
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujino
authors.forename: Kiyonori
authors.initials: K
authors.lastname: Kanemitsu
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Goto
authors.forename: Takashi
authors.initials: T
authors.lastname: Kamigaki
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kuroda
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Kuroda
mesh_terms: D000818:Animals; D007422:Intestines / Q000601:surgery*; D011312:Pressure; D013528:Surgical Staplers; D017792:Surgical Stapling / Q000379:methods*; D013552:Swine; D013718:Tensile Strength