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01-04-2009

A comparison of gastrojejunal anastomoses with or without buttressing in a porcine model

Authors: William W. Hope, Marc Zerey, Thomas M. Schmelzer, William L. Newcomb, B. Lauren Paton, Jessica J. Heath, Richard D. Peindl, H. James Norton, Amy E. Lincourt, B. Todd Heniford, Keith S. Gersin

Published in: Surgical Endoscopy | Issue 4/2009

Abstract

Introduction

The addition of staple-line reinforcements on circular anastomoses has not been well studied. We histologically and mechanically analyzed circular- stapled anastomoses with and without bioabsorbable staple-line reinforcement (SeamGuard^®, W. L. Gore & Associates, Flagstaff, AZ) in a porcine model.

Methods

Gastrojejunal anastomoses were constructed using a #25 EEA Proximate ILS^® (Ethicon Endo-Surgery, Cincinnati, OH) mechanical stapling device with and without Bioabsorbable SeamGuard^® (BSG). Gastrojejunal anastomoses were resected acutely and at 1 week, and burst-pressure testing and histological analysis were performed. Standardized grading systems for inflammation, collagen deposition, vascularity, and serosal inflammation were used to compare the two anastomosis types.

Results

Acute burst pressures were significantly higher with BSG than with staples alone (1.37 versus 0.39 psi, p = 0.0075). Burst pressures at 1 week were significantly lower with BSG than with staples alone (2.24 versus 3.86 psi, p = 0.0353); however, both readings were above normal physiologic intestinal pressures. There was no statistical difference in inflammation (13.4 versus 15.6, p = 0.073), width of mucosa (3.2 mm versus 3.2 mm, p = 0.974), adhesion formation (0 versus 0.5, p = 0.575), number of blood vessels (0.5 versus 1.0, p = 0.056), or serosal inflammation (2.0 versus 1.0, p = 0.27) between the stapled anastomoses and those buttressed with BSG. Stapled-only anastomoses had statistically more collagen (2.0 versus 1.0, p = 0.005) than the anastomoses supported with BSG.

Conclusions

The addition of BSG as a staple-line reinforcement acutely improves the burst strength of a circular anastomosis but not at 1 week. At 1 week, a decrease in collagen content with the BSG-buttressed stapled anastomosis was the only difference in the histologic parameters studied with no difference in vascularity, adhesions, or inflammation. The long-term effect of BSG on anastomotic strength or scarring is yet to be determined. The clinical implications may include decreased stricture formation and also decreased strength at anastomoses.

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Title: A comparison of gastrojejunal anastomoses with or without buttressing in a porcine model
Authors: William W. Hope
Marc Zerey
Thomas M. Schmelzer
William L. Newcomb
B. Lauren Paton
Jessica J. Heath
Richard D. Peindl
H. James Norton
Amy E. Lincourt
B. Todd Heniford
Keith S. Gersin
Publication date: 01-04-2009
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 4/2009
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-008-0079-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A comparison of gastrojejunal anastomoses with or without buttressing in a porcine model

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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