Compression injury of the circular stapler for gastrointestinal end-to-end anastomosis: preliminary in-vitro study

Gyung Mo Son; Myeong Sook Kwon; Hong-min Ahn; In Young Lee; Gun Ho Kim; Kyoung Won Nam; JoonWon Lee; Chang-Suk Kong

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저자정보: Gyung Mo Son (Pusan National University School of Medicine) Myeong Sook Kwon (Pusan National University Yangsan Hospital) Hong-min Ahn (Pusan National University School of Medicine) In Young Lee (Pusan National University Yangsan Hospital) Gun Ho Kim (Pusan National University School of Medicine) Kyoung Won Nam (Pusan National University School of Medicine) JoonWon Lee (University of Birmingham) Chang-Suk Kong (Silla University)

저널정보: 대한외과학회 Annals of Surgical Treatment and Research Annals of Surgical Treatment and Research Vol.99 No.2

발행연도: 2020.8

수록면: 72 - 81 (10page)

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Purpose: This preliminary in-vitro study was designed to evaluate the risk factors of compression injury from use of a circular stapler for end-to-end anastomosis.
Methods: Transparent collagen plates were prepared in dry and wet conditions. Physical properties of collagen plates and porcine colon tissue were examined using a rheometer. Adjustable and fixed-type circular staplers were applied on the collagen plates and the gap distance and compressive pressure were measured during anvil approximation. Tissue injury was evaluated using a compression injury scale. Compression properties were accessed to optimal or overcompression based on gap distance.
Results: Unacceptable injuries were rarely observed on the dry collagens, regardless of compression device. In the adjustable compression, the compressibility ratio was similar between dry and wet collagen. Overcompression and unacceptable injury increased on the wet collagens. In the fixed compression, the compressibility ratio increased significantly and unacceptable injuries were observed in more than 50% of wet collagens. Peak pressure was significantly higher in the fixed-compression types than those of adjustable type. On bivariate correlation analysis, fixed-compression type and wet collagens were respectively associated with overcompression. On multivariate analysis, edematous collagen condition was the most important risk factor and proximal anvil side, fixed compression type, and overcompression were also independent risk factors for unacceptable compression injury.
Conclusion: In the edematous tissue condition, unintentional overcompression could be increased and result in tissue injury on the compression line of the circular stapler.

#Anastomotic leak #Colorectal surgery #Soft tissue injuries #Surgical anastomosis #Surgical staplers

참고문헌 (21)

참고문헌 신청

Nakayama S / 2015 / Obtaining secure stapling of a double stapling anastomosis / J Surg Res 193:652~657

Ikeda T / 2015 / Endoscopic evaluation of clinical colorectal anastomotic leakage / J Surg Res 193:126~134

Offodile AC 2nd / 2010 / High incidence of technical errors involving the EEA circular stapler : a single institution experience / J Am Coll Surg 210:331~335

Slieker JC / 2013 / Systematic review of the technique of colorectal anastomosis / JAMA Surg 148:190~201

Mery CM / 2008 / Profiling surgical staplers : effect of staple height, buttress, and overlap on staple line failure / Surg Obes Relat Dis 4:416~422

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