![]() Primary outcome was assessed in terms of intra-operative staple line bleeding, operative time and post-operative anastomotic leak. They were randomly allocated to two groups, Group A which underwent laparoscopic intestinal anastomosis by Endo GIA tri-staple (purple) stapler and Group B which underwent Endo GIA universal loading unit (blue/green) stapler. Methods: A prospective comparative study of 50 cases which met the inclusion and exclusion criteria were included in this hospital-based study. ![]() Few previous studies evaluating the clinical safety of the 2 laparoscopic linear stapling devices are available. Various evolvements have occurred in the field of intestinal anastomosis and recent advancement is the use of stapler in laparoscopic surgeries as a device for Gastrointestinal (GI) anastomosis. Hospital and Government Medical College, Bhavnagar, Gujarat, IndiaĪnastomotic leak, Endo GIA, Staple line, Laparoscopic intestinal anastomosis, Linear stapler, Stapler angulation Abstractīackground: Intestinal anastomosis is a commonly performed procedure in surgery. With proper instruction, SFEEA has been demonstrated to be a reliable tool for surgeons and may be useful during emergency situations to decrease operative time in unstable patients when a rapid anastomosis is required and to potentially decrease dehiscence risk in patients with septic peritonitis.Department of Surgery, Sir T. 14 Furthermore, in another retrospective study, SFEEA was found to be less likely to undergo dehiscence as compared with hand-sewn intestinal anastomosis in dogs with preoperative septic peritonitis. Preoperative peritonitis was examined and was not an identified risk factor for SFEEA, contrary to previous reports. 16 In a retrospective study examining risk factors specifically related to SFEEA dehiscence, preoperative presence of inflammatory bowel disease, intraoperative hypotension, and resection and anastomosis involving the large intestine were identified as risk factors. Preoperative peritonitis, a serum albumin concentration less than 2.5 g/dL (25 g/L), and presence of an intestinal foreign body are classically reported risk factors for intestinal anastomosis dehiscence following hand-sewn anastomosis. 14 However, in some institutions, the total procedural time saved may result in equivalent overall costs between SFEEA and hand-sewn anastomosis. An additional limiting factor of stapled anastomosis may be financial investment, with SFEEA instruments and staple cartridges costing 15 to 25 times more than suture costs. 12ĭisadvantages of SFEEA as compared with hand-sewn anastomosis include the learning curve required to perform the procedure and the inability to perform this procedure in areas of the GI tract other than the jejunum and ascending duodenum. A multi-institutional retrospective study in dogs demonstrated no significant difference in anastomosis dehiscence rates or decreased procedure time with SFEEA as compared with hand-sewn anastomosis. 13-15 In addition, severe luminal disparity between 2 cut bowel ends (eg, severe segmental dilation orad to an obstructive foreign body) can be readily resolved via SFEEA. 1,12-14 Potential benefits of SFEEA as compared with hand-sewn anastomosis include reduced procedure time, decreased tissue trauma, decreased intraoperative contamination, consistency and repeatability of the anastomosis, and preservation of blood supply. Studies have been conducted to evaluate the technique and outcome of SFEEA in veterinary medicine. Other portions of the intestine (eg, duodenum, large intestine) are more fixed because of the short mesentery, precluding the use of this technique. ![]() 10,11 Ideally, SFEEA is used following enterectomy of the jejunum and/or ascending duodenum based on the mobility of this portion of the small intestine. ![]() Stapled GIA in dogs and cats and, more recently, a technique in dogs for a stapled functional end-to-end anastomosis (SFEEA) using only a GIA stapler have also been reported. Inverting EEA using an EEA circular staplerĪntiperistaltic side-to-side (ie, functional end-to-end) anastomosis using a GI anastomosis (GIA) linear and/or cutting stapler In human and veterinary medicine, stapling devices have been developed for GI surgery, and a variety of different stapling techniques for intestinal anastomosis have been described, including 1-10:Įverting, triangulating end-to-end anastomosis (EEA) using a thoracoabdominal linear stapler Intestinal resection and anastomosis is commonly performed in small animal practice to remove segments of bowel that are devitalized or diseased, often due to foreign material or neoplasia. ![]()
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