Experimental Evaluation of Staple Lines in Gastric Surgery

Bluett, Michael K.

doi:10.1001/archsurg.1987.01400190038007

Cited by 10 publications

(2 citation statements)

References 9 publications

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“…It may be argued that the preceding inflation test may have affected the results of the subsequent tensile strength test. Bluett et al [6]and De Waard et al [7], however, demonstrated that the breaking strength remained the same whether or not it was preceded by the BP test. The lack of correlation during the early phase is further verified by the fact that the correlation coefficients were increased to a highly significant level during the subsequent fibroplastic phase in spite of using the same model.…”

Section: Discussionmentioning

confidence: 99%

Correlation of Tensile Strength with Bursting Pressure in the Evaluation of Intestinal Anastomosis

et al. 1999

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Background: Although bursting pressure and tensile strength have long been measured to evaluate anastomotic techniques, it has yet to be clarified whether or not they are correlated, what implications they have, and which should be used as a gold standard. Material and Methods: Using an experimental model to estimate pressure and tension in the same colonic anastomosis, the following variables were measured in 48 rats between days 0 and 14: bursting pressure (BP); minimal tensile strength (MITS) necessary to break a part of the anastomosis, and maximal tensile strength (MATS) needed to disrupt the whole anastomosis. Also, circulatory wall tension (CWT) was derived from BP and the anastomotic circumference (AC), and longitudinal wall tension (LWT) from MITS and AC. These variables were compared using correlation and regression analysis. Results: During the lag phase (days ≤4) there was poor correlation between pressure-related and tension-related variables whereas highly significant correlations were noted in the subsequent fibroplastic phase (day ≥5). It was shown by regression lines that positive MITS and MATS were expected when BP was zero. Conclusion: Contrary to the previous assumption, no correlation was found between BP and tensile strength in the critical postoperative period. Based on our present and previous studies, measurement of MITS is recommended to evaluate the healing of colonic anastomosis.

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Section: Discussionmentioning

confidence: 99%

Correlation of Tensile Strength with Bursting Pressure in the Evaluation of Intestinal Anastomosis

et al. 1999

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“…This article focuses on the stapled functional end-to-end anastomosis, which was first described by Steichen [1]. Poth [2] demonstrated improvement in the instruments, but by increasing the indications [4,5] and establishing the scientific basis of the procedure [6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Review of 200 Stapled Functional End-to-End Anastomoses

Kusunoki¹,

Yanagi²,

Sakanoue³

et al. 1993

Dig Surg

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A consecutive series of 200 cases of functional end-to-end anastomosis performed using linear stapling devices was reviewed. We employed three types of operation: a closed luminal two-stage method (type 1a); an open luminal two-stage method (type 1b), and a one-stage method (type 2). Complications occurred in 17 of 200 patients (8.5%), and included 8 cases of anastomotic leakage, 5 cases of intestinal obstruction, 2 cases of bleeding, and 2 cases of wound sepsis. Complications developed in 4 of 39 patients (10.3%) undergoing anastomosis by procedure 1a; 3 of 23 patients (13.0%) having procedure 1b, and 10 of 138 patients (7.2%) having procedure 2. Anastomotic dehiscence occurred at the intersection of two staple lines in 7 of 8 cases (87.5%). Our 2 hemodialysis patients developed anastomotic leakage and massive anastomotic bleeding, respectively. In this series, satisfactory results were achieved by the stapling procedure under a variety of circumstances. It might be useful to add reinforcing sutures at the intersections of the staple lines and to check for bleeding at the distal staple line when using a linear anastomotic instrument. Our experience suggested that we should carefully control the three corners of the anastomotic triangle to prevent complications.

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