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In vitro comparison of leakage pressure and leakage location for various staple line offset configurations in functional end-to-end stapled small intestinal anastomoses of canine tissues.

OBJECTIVE
To compare intraluminal pressure at initial leakage (leakage pressure), leakage location, and maximum intraluminal pressure (MIP) for various staple line offset configurations of functional end-to-end stapled anastomosis (FEESA).


SAMPLE
Grossly normal jejunal segments from 4 canine cadavers.


PROCEDURES
52 jejunal segments (4 control and 24 anastomosis constructs [2 segments/standard FEESA construct]) were prepared for testing. Segments were assigned to three 8-segment gastrointestinal anastomosis staple line offset groups: complete offset (CSO group), partial gastrointestinal anastomosis offset (PSO group), and no gastrointestinal anastomosis offset (NSO group). Results for leakage pressure, leakage location, and MIP were compared.


RESULTS
Mean ± SD leakage pressure differed significantly among all groups and was highest for the PSO group (34.4 ± 3.7 mm Hg), followed by the CSO group (25.9 ± 4.1 mm Hg) and the NSO group (18.8 ± 1.5 mm Hg). Leakage location did not differ significantly among groups but was most commonly associated with the thoracoabdominal staple line. The MIP did not differ significantly among groups (PSO, 83.1 ± 9.4 mm Hg; CSO, 81.7 ± 6.7 mm Hg; and NSO, 58.5 ± 7.7 mm Hg).


CONCLUSIONS AND CLINICAL RELEVANCE
In this study, partial staple line offset leaked at a significantly higher pressure, which represented the greatest leakage protection of tested constructs. The thoracoabdominal staple line was more susceptible to leakage than was the gastrointestinal anastomosis staple line. Results suggested that surgeons should avoid FEESA with no staple line offset, strive for partial offset of the gastrointestinal anastomosis staples, and provide precise placement of the thoracoabdominal staple line.