title: A novel single-stapling technique for colorectal anastomosis: a pre-ligation single-stapling technique (L-SST) in a porcine model.
abstract: BACKGROUND
  In low anterior resections, anastomosis continues to present major problems. Although the single-stapling technique (SST) is considered to be superior to the double-staple technique (DST) in terms of leakage and stenosis, SST requires suturing, which is particularly difficult during laparoscopic surgery. A simpler and safer method of anastomosis is needed. In this study, we developed a pre-ligation SST (L-SST) that does not require suturing and evaluated the usefulness of L-SST in an ex vivo and an in vivo porcine model.
  
  
  METHODS
  Porcine rectums were ligated using SurgiTie™ and sharply resected instead of using a linear stapler. The burst pressures of the closed rectums after using a linear stapler and SurgiTie™ (each group; n = 5) and the burst pressures of the anastomoses performed with L-SST and DST (each group; n = 4) were measured. During in vivo porcine laparoscopic surgery, we performed and evaluated the feasibility of L-SST.
  
  
  RESULTS
  After completing the anastomosis with L-SST, the ligated portion using SurgiTie™ was completely removed. The stump closed using SurgiTie™ was much stronger than that closed using a stapler (131.2 and 25.6 mmHg, respectively; P = 0.01). The average burst pressure of the anastomoses performed with L-SST was 33.8 mmHg, whereas that performed with DST was 30.5 mmHg. We did not find significant difference between these two groups (P = 0.88). We also confirmed the feasibility of L-SST in an in vivo porcine laparoscopic surgery model.
  
  
  CONCLUSIONS
  We developed a novel SST, the L-SST. We were able to perform L-SST successfully using an ex vivo porcine rectum and during in vivo porcine laparoscopic surgery.
authors.affiliation: Department of Surgery, Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takeyama
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Taishi
authors.initials: T
authors.lastname: Hata
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Masahisa
authors.initials: M
authors.lastname: Ohtsuka
authors.forename: Ryoji
authors.initials: R
authors.lastname: Nonaka
authors.forename: Akira
authors.initials: A
authors.lastname: Inoue
authors.forename: Atsushi
authors.initials: A
authors.lastname: Naito
authors.forename: Tae
authors.initials: T
authors.lastname: Matsumura
authors.forename: Mamoru
authors.initials: M
authors.lastname: Uemura
authors.forename: Junichi
authors.initials: J
authors.lastname: Nishimura
authors.forename: Ichiro
authors.initials: I
authors.lastname: Takemasa
authors.forename: Tsunekazu
authors.initials: T
authors.lastname: Mizushima
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D057868:Anastomotic Leak / Q000517:prevention & control; D000818:Animals; D003106:Colon / Q000601:surgery*; D008026:Ligation / Q000295:instrumentation; D023421:Models, Animal; D012007:Rectum / Q000601:surgery*; D017792:Surgical Stapling / Q000379:methods*; D013552:Swine