Automatic staple suturing for gastrointestinal surgery

Surgical stapling of the small intestine

Intestinal resection and anastomosis, bypass enterostomy, and typhlectomy are indicated for many intestinal disorders. The thoracoabdominal and end-to-end anastomosis stapling instruments all may be used to perform a variety of small intestinal surgical procedures.

Pitfalls in use of stapler in gastrointestinal tract surgery

The development of stapling instruments has been an enormous advancement in surgery of the gastrointestinal tract. No instrument, however, can replace sound surgical judgment and technique.

Open Intestinal Anastomosis with Surgical Stapling Equipment in 24 Dogs and Cats

Surgical stapling equipment was used to perform open antiperistaltic side-to-side ("functional end-to-end") entero-anastomoses in 20 dogs and 4 cats. Twenty-one anastomoses healed uneventfully. Seven animals with severe bacterial peritonitis required open peritoneal drainage and delayed abdominal closure. There was postoperative leakage at the anastomotic site in two dogs and a localized abscess at the staple line in one cat. No long-term complications occurred in follow-up periods of 3 to 29 months.

Billroth II gastrojejunostomy in dogs. Stapling technique and postoperative complications

Billroth II gastrojejunostomy was performed with surgical staplers in 6 dogs that were not irradiated and in 11 dogs that subsequently received radiation to the pancreas and proximal part of the duodenum. The dogs were monitored clinically for 135 days and then euthanatized and necropsied. Each gastrojejunostomy site was preserved in formalin and the stomal diameter was measured. No mechanical complications were encountered with the use of surgical staplers and no leakage was observed at the staple closure sites before abdominal closure. All dogs vomited approximately 100 ml of coagulated blood 4 to 8 hours after surgery, and 300 to 400 ml of brown fluid after approximately 24 hours. Vomiting was the most common clinical finding after the first 24 hours. Vomiting was subjectively graded from 1 to 3 with grade 1 representing the least severe problem and grade 3 the most severe. Grade 1 vomiting occurred in 12 of 16 dogs that survived 135 days; in the other four dogs, vomiting was classified as grade 2 or 3. All dogs with grade 1 vomiting had stomal diameters of 1.7 to 2.9 cm (mean, 2.2 +/- 0.4 cm standard deviation). Dogs with grade 2 or 3 vomiting had stomal diameters of 2.2 to 4.0 cm (mean, 3.2 +/- 0.8 cm standard deviation). The difference was statistically significant (p less than 0.005). The percentage of weight gained or lost was recorded for each dog. Two nonirradiated dogs gained body weight, whereas the other nonirradiated dogs and all irradiated dogs lost body weight.(ABSTRACT TRUNCATED AT 250 WORDS)

Closure of double-barrel colostomy with stapling instruments

A technique for closure of double-barrel colostomies using the GIA and TA 90 stapling instruments is described. The method is straight forward and time saving, and represents a further application of automatic staplers to gastro-intestinal surgery.

The staple closure of loop colostomy

A technique of colostomy closure using the TA55 stapling instrument is described. No serious complications were encountered using this technique in a series of 20 consecutive loop colostomy closures.

Oesophagogastrectomy using the end-to-end anastomosing stapler

The use of a mechanical instrument for accomplishing end-to-side oesophagogastrostomy is described. We report our experience with 30 consecutive patients undergoing oesophagogastrectomy--26 for malignant disease and four for benign peptic stricture. There were two immediate postoperative deaths. One patient developed a chylothorax and died six weeks after operation. The instrument failed to function satisfactorily on one occasion. There were no anastomotic leaks.

Esophagogastrectomy using the auto suture EEA surgical stapling instrument

A stapling instrument, which creates end-to-end inverting anastomoses, is described for esophagogastrostomy. The inverted anastomosis is held together by a double staggered row of stainless-steel wire staples. Experience with 7 consecutive patients who underwent esophagogastrectomy for carcinoma of the distal esophagus or proximal stomach using this device is reported. Postoperative complications included atelectasis in 1 patient, cardiac failure in 1, and pneumonia in 1. A fibrotic stricture developed at the anastomotic site 5 months postoperatively in 1 patient. There were no anastomotic leaks. The stapled anastomosis takes 2 to 3 minutes to perform and seems to be at least comparable to handsewn anastomoses.

Staplers in gastrointestinal surgery

Although gastrointestinal staplers have a definite place in surgery because they are safe and effective, their distinct advantages are not clear cut. Surgeons in training should be accomplished in conventional suturing techniques before learning stapler techniques for similar anastomoses.

Prospective controlled study of gastrointestinal stapled anastomoses

A controlled prospective study was carried out in a university-affiliated community hospital to evaluate the use of gastrointestinal staples compared with conventional sutures for anastomotic construction. The study included 100 randomized cases (50 sutured and 50 stapled) requiring anastomoses. Consecutive patients were accepted into the study, and no patients were excluded. There was no significant difference between the two groups in operating room time or the duration of postoperative hospitalization, nasogastric intubation or intravenous intubation. The complication rate was similar and comparable to previously published results. On three occasions, it was necessary during operation to convert from the use of staples to sutures when immediate disruption was noted at a gastroduodenal anastomosis.

The stapled gastrointestinal tract anastomosis: incidence of postoperative complications compared with the sutured anastomosis

Performance of gastrointestinal anastomosis by means of surgical stapling devices has achieved popularity in the last decade even though no detailed study has been reported comparing complications following the stapled anastomosis with those following hand sutured procedures performed by the same surgeons. We have reviewed 812 operative procedures on the gastrointestinal tract performed in one hospital over a four year period. Stapled anastomoses were performed in 472 with 13 (2.8%) complications related to the anastomosis; in 296 sutured anastomoses there were nine (3.0%) related complications. Comparison did not disclose any significant difference in the number of complications in these two groups. In 44 instances wherein the anastomosis contained both staples and sutures, there were no related complications. Further analysis of the patients in each group disclosed that stapling procedures were utilized in a much higher percentage of those operations which were performed under emergency conditions or in the presence of intra-abdominal sepsis, intestinal obstruction, and carcinomatosis. If the technical details of surgical stapling are mastered, this technique appears to be as safe as suturing in the performance of anastomoses in the gastrointestinal tract.

Mechanical suture methods in thoracic and abdominal surgery

Mechanical suturing procedures on the bowel, lung, bronchi and pulmonary vessels have been used on 264 occasions in 180 thoracic and abdominal operations. The instruments proved simple to use and produced reliable good quality closures, for the most part without manual reinforcement. There were 2 technical failures, one ending fatally, after colo-colostomy. Two minor postoperative suture leaks were encountered in 122 operations on the alimentary tract, but no leakage or other problem has arisen in 58 pulmonary cases. The staple-suturing methods described are safe and straightforward, and it is believed that they represent a significant advance in the techniques of thoracic and abdominal surgery, which can usefully be applied in many situations.