Intersecting staple lines in intestinal anastomoses

Abstract

With the wide application of the stapling instruments in thoracic and general surgery, a number of techniques have been introduced that involve intersecting staple lines. If these simply involve two applications of the liner staplers (TA series), the problem is only one of the effect of the intersection on the circulation, particularly at the corner. With the GIA linear anastomotic instruments or the EEA circular anastomotic instrument, the question arises as to the integrity of the staple line that is cut through by the knives in these instruments. A large experience here and abroad attests to the safety of the TA intersecting lines in intestine and lung, presumably because the circulation continues through the staple line. The use of the circular anastomosing instrument, EEA, across linear staple lines has been spreading clinically with good reports. Studies were undertaken in dogs of the fate of the TA staple lines when the EEA stapler was used for rectal resection or for a Billroth I gastroduodenal reconstruction. In 20 rectal anastomoses and 10 Billroth I reconstructions, there were no leaks, dehiscences, or evidences of failure, whether the EEA transsected the linear staple line once or twice. Most frequently the knife bent the intersected staple and transferred it to the doughnut that was removed. Much less frequently a staple was cleanly transsected by the knife, and only twice did we see no evidence of damage to the staples in the TA line.