Use of bioabsorbable staple reinforcement material in side-to-side anastomoses: Suture line reinforcement of the weak point of the anastomosis

Background: Few studies have been designed regarding optimal reinforcement of the crotch of a side-to-side anastomosis. The purpose of this study was to clarify the weak point of the side-to-side anastomosis and to evaluate the effect of bioabsorbable reinforcement material. Methods: Fresh pig small bowel was used for all experiments. A side-to-side anastomosis was performed using a linear stapler, and the burst pressure of the anastomosis was measured. Three separate experiments were done. In experiment 1, the weak point and the burst pressure of that point were defined. In experiment 2, the burst pressure of the side of the anastomosis was measured. In experiment 3, we evaluated the effect of Neoveil (R) to strengthen the weak point of the anastomosis. Results: The weak point of the side-to side anastomosis was the crotch and the burst pressure was 39.8 +/- 5.7 mmHg. The burst pressure of the side of the anastomosis was 109.9 +/- 7.9 mmHg. This was significantly higher than the burst pressure of the crotch (P = 0.008). The burst pressure of the crotch in the group with Neoveil (R) was 83.3 +/- 14.9 mmHg. This pressure was significantly higher than the group with no Neoveil (R) reinforcement (P = 0.001). Conclusion: These findings suggest that the use of Neoveil (R) as a buttressing material is associated with reinforced staple lines and increased crotch burst pressures compared to non-buttressed staple lines. Neoveil (R) was found to perform comparably to clinically available buttress materials in this ex vivo model. Reinforcement of the weak point of the side-to-side anastomosis with Neoveil (R) may lead to fewer anastomotic leaks. (C) 2016 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Limited.