title: A comparison of gastrojejunal anastomoses with or without buttressing in a porcine model.
abstract: BACKGROUND
  The addition of staple-line reinforcements on circular anastomoses has not been well studied. We histologically and mechanically analyzed circular- stapled anastomoses with and without bioabsorbable staple-line reinforcement (SeamGuard, W. L. Gore & Associates, Flagstaff, AZ) in a porcine model.
  
  
  METHODS
  Gastrojejunal anastomoses were constructed using a #25 EEA Proximate ILS (Ethicon Endo-Surgery, Cincinnati, OH) mechanical stapling device with and without Bioabsorbable SeamGuard (BSG). Gastrojejunal anastomoses were resected acutely and at 1 week, and burst-pressure testing and histological analysis were performed. Standardized grading systems for inflammation, collagen deposition, vascularity, and serosal inflammation were used to compare the two anastomosis types.
  
  
  RESULTS
  Acute burst pressures were significantly higher with BSG than with staples alone (1.37 versus 0.39 psi, p=0.0075). Burst pressures at 1 week were significantly lower with BSG than with staples alone (2.24 versus 3.86 psi, p=0.0353); however, both readings were above normal physiologic intestinal pressures. There was no statistical difference in inflammation (13.4 versus 15.6, p=0.073), width of mucosa (3.2 mm versus 3.2 mm, p=0.974), adhesion formation (0 versus 0.5, p=0.575), number of blood vessels (0.5 versus 1.0, p=0.056), or serosal inflammation (2.0 versus 1.0, p=0.27) between the stapled anastomoses and those buttressed with BSG. Stapled-only anastomoses had statistically more collagen (2.0 versus 1.0, p=0.005) than the anastomoses supported with BSG.
  
  
  CONCLUSIONS
  The addition of BSG as a staple-line reinforcement acutely improves the burst strength of a circular anastomosis but not at 1 week. At 1 week, a decrease in collagen content with the BSG-buttressed stapled anastomosis was the only difference in the histologic parameters studied with no difference in vascularity, adhesions, or inflammation. The long-term effect of BSG on anastomotic strength or scarring is yet to be determined. The clinical implications may include decreased stricture formation and also decreased strength at anastomoses.
authors.affiliation: Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, North Carolinas HealthCare System, 1000 Blythe Blvd., MEB 601, Charlotte, NC 28203, USA.
authors.forename: William W
authors.initials: WW
authors.lastname: Hope
authors.forename: Marc
authors.initials: M
authors.lastname: Zerey
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Schmelzer
authors.forename: William L
authors.initials: WL
authors.lastname: Newcomb
authors.forename: B Lauren
authors.initials: BL
authors.lastname: Paton
authors.forename: Jessica J
authors.initials: JJ
authors.lastname: Heath
authors.forename: Richard D
authors.initials: RD
authors.lastname: Peindl
authors.forename: H James
authors.initials: HJ
authors.lastname: Norton
authors.forename: Amy E
authors.initials: AE
authors.lastname: Lincourt
authors.forename: B Todd
authors.initials: BT
authors.lastname: Heniford
authors.forename: Keith S
authors.initials: KS
authors.lastname: Gersin
mesh_terms: D000713:Anastomosis, Roux-en-Y / Q000379:methods; D000818:Animals; D001672:Biocompatible Materials; D003094:Collagen / Q000378:metabolism; D004195:Disease Models, Animal; D004867:Equipment Design; D005260:Female; D007413:Intestinal Mucosa / Q000378:metabolism / Q000473:pathology; D007583:Jejunum / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D011312:Pressure; D013270:Stomach / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D017792:Surgical Stapling / Q000295:instrumentation*; D013537:Sutures; D013552:Swine
chemical_list: D001672:Biocompatible Materials; D003094:Collagen