Technical characteristics can make the difference in a surgical linear stapler. Or not?
BACKGROUND
Anastomotic leak (AL) after gastrointestinal surgery is a severe complication associated with relevant short- and long-term sequelae. Most of the anastomosis are currently performed with a surgical stapler that is required to have appropriate characteristics to guarantee good performances. The aim of our study was to evaluate, in the laboratory, pressure resistance and tensile strength of anastomosis performed with different surgical linear staplers, available in the market.


METHODS
We have been studying three linear staplers, with diverse cartridges and staple heights, of three different companies, used for gastrointestinal anastomosis and gastric or intestinal closure. We performed 50 anastomosis for each device, with the pertinent different cartridges, on fresh pig intestine, for a total of 350 anastomosis, then injected saline solution and recorded the pressure that provokes a leak on the staple line. There were no statistically significant differences between the mean pressure necessary to induce an AL in the various instruments (P > 0.05). For studying the tensile strength, we performed a total of 350 anastomosis with the different linear staplers on a special strong paper (Tyvek), then recorded the maximal tensile force that could open the anastomosis.


RESULTS
There were no statistically significant differences between the different staplers about the strength necessary to open the staple line (P > 0.05).


CONCLUSIONS
we demonstrated that different linear staplers of three companies available in the market give comparable anastomotic pressure resistance and tensile strength. This might suggest that small dissimilarities between different devices are not involved, at least as major parameters, in AL etiology.
Department of Surgical and Medical Sciences and Translational Medicine, General Surgery Unit, Sant'Andrea Hospital, 'Sapienza' University of Rome, Rome, Italy. Electronic address: v.giaccaglia@gmail.com.
Valentina
V
Giaccaglia
Department of Surgical and Medical Sciences and Translational Medicine, General Surgery Unit, Sant'Andrea Hospital, 'Sapienza' University of Rome, Rome, Italy.
Maria Serena
MS
Antonelli
Department of Surgical and Medical Sciences and Translational Medicine, General Surgery Unit, Sant'Andrea Hospital, 'Sapienza' University of Rome, Rome, Italy.
Paola
P
Addario Chieco
Department of General and Emergency Surgery, 'Paolo Giaccone' University Hospital, Palermo, Italy.
Gianfranco
G
Cocorullo
Department of Surgical and Medical Sciences and Translational Medicine, General Surgery Unit, Sant'Andrea Hospital, 'Sapienza' University of Rome, Rome, Italy.
Marco
M
Cavallini
Department of General and Emergency Surgery, 'Paolo Giaccone' University Hospital, Palermo, Italy.
Gaspare
G
Gulotta
D000714:Anastomosis, Surgical / Q000295:instrumentation; D057868:Anastomotic Leak / Q000517:prevention & control*; D000818:Animals; D001696:Biomechanical Phenomena; D004867:Equipment Design; D007422:Intestines / Q000601:surgery*; D011312:Pressure; D013528:Surgical Staplers; D017792:Surgical Stapling / Q000295:instrumentation*; D013552:Swine; D013718:Tensile Strength
Pressure resistance; Surgical linear stapler; Surgical stapler; Tensile strength