Weak Points of a Stapled Side-to-Side Anastomosis.

Background/aims: In recent years, the side-to-side intestinal anastomosis has become a widely used technique. The purpose of this study was to evaluate the difference in the burst pressures and weak points using three different kinds of suture instruments.

Methodology: Fresh pig esophagus and small bowel were used for all experiments. A side-to-side anastomosis was performed using three linear staplers, and the burst pressure was measured. Stapling devices used were the GIATM60-3.8, Endo GIATM60-3.5 and 60AMT.

Results: In the GIATM6O-3.8 group, mean burst pressure was 34.5mmHg, with the burst point being the side of the staple line in one case, the side and the crotch simultaneously in two cases, and the crotch alone in two cases. In the GIA TM60-3.5 and 60AMT groups, mean burst pressure was 74.3 mmHg and 55.5 mmHg, and the burst point was the crotch in all cases. The difference between the instruments was significant.

Conclusion: With two-row stapling devices, the side and the crotch of the staple line are equally weak. On the other hand, three-row staplers have not only greater burst pressures, but also the only weak point is the crotch. Thus, crotch reinforcement in side- to-side stapled anastomoses is critical regardless of the amount of rows used.