title: Different characteristics of circular staplers make the difference in anastomotic tensile strength.
abstract: Anastomotic leak after gastrointestinal surgery is a severe complication associated with relevant short and long-term sequelae. Most of the anastomoses are currently performed with a surgical stapler that is required to have appropriate characteristics in order to guarantee good performances. The aim of our study was to evaluate, ex vivo, pressure resistance and tensile strength of anastomosis performed with different circular staplers available in the market. We studied 7 circular staplers of 3 different companies, 3 of them used for gastrointestinal anastomosis and 4 staplers for hemorrhoidal prolapse excision. A total of 350 anastomoses, 50 for each of the 7 staplers, were performed using healthy pig fresh intestine, then injected saline solution and recorded the leaking pressure. There were no statistically significant differences between the mean pressure necessary to induce an anastomotic leak in the various instruments (p>0.05). For studying tensile strength, we performed a total of 350 anastomoses with 7 different circular staplers on a special strong paper (Tyvek), and then recorded the maximal tensile force that could open the anastomosis. There were statistically significant differences between one brand stapler vs other 2 companies staplers about the strength necessary to open the staple line (p<0.05). In conclusion, we demonstrated that different circular staplers of three companies available in the market give comparable anastomotic pressure resistance but different tensile strengths. This is probably due to different technical characteristics.
authors.affiliation: Department of Surgical and Medical Sciences and Translational Medicine, General Surgery and Emergency Surgery Units, Sant'Andrea Hospital, 'Sapienza' University of Rome, Italy. Electronic address: v.giaccaglia@gmail.com.
authors.forename: V
authors.initials: V
authors.lastname: Giaccaglia
authors.affiliation: Department of Surgical and Medical Sciences and Translational Medicine, General Surgery and Emergency Surgery Units, Sant'Andrea Hospital, 'Sapienza' University of Rome, Italy.
authors.forename: M S
authors.initials: MS
authors.lastname: Antonelli
authors.affiliation: Department of General Surgery, Tor Vergata University Hospital, 'Tor Vergata' University of Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Franceschilli
authors.affiliation: Department of Surgical and Medical Sciences and Translational Medicine, General Surgery and Emergency Surgery Units, Sant'Andrea Hospital, 'Sapienza' University of Rome, Italy.
authors.forename: P F
authors.initials: PF
authors.lastname: Salvi
authors.affiliation: Department of General Surgery, Tor Vergata University Hospital, 'Tor Vergata' University of Rome, Italy.
authors.forename: A L
authors.initials: AL
authors.lastname: Gaspari
authors.affiliation: Department of General Surgery, Tor Vergata University Hospital, 'Tor Vergata' University of Rome, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Sileri
mesh_terms: D000714:Anastomosis, Surgical / Q000295:instrumentation*; D000818:Animals; D013505:Digestive System Surgical Procedures; D008297:Male; D011312:Pressure; D013528:Surgical Staplers; D013552:Swine; D013718:Tensile Strength