In-continuity gastrointestinal stapling

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Abstract
Several surgical procedures have been proposed to interrupt continuity of the gut, without transection, by means of a row of staples. Using the dog, the functional and histologic results of in-continuity stapling of the gastric antrum, the small intestine and the colon were investigated. After creation of an end antrostomy, ileostomy or colostomy, a staple line was placed proximal to the stoma (TA 55-4.8 mm staples). Decompression of the bowel proximal to the staple line was accomplished by an enteric anastomosis. Separation of the staple closure was detected by intestinal contents exiting from the stoma. Animals were sacrificed at the time of disruption, and specimens were obtained for histologic examination. Three of 5 antral closures broke down at a mean of 19.6 days after operation. All 5 small-bowel staple lines opened at a mean of 12.4 days. Five of 5 colonic staple lines disrupted 13.0 days postoperatively. The staples pulled through the bowel wall without losing their B shaped configuration. Microscopic examination showed intact mucosa across the staple line, with no submucosa to submucosa healing. Staple lines in the undivided small bowel or colon disrupt after .apprx. 2 wk due to lack of fibrotic healing. Staple interruptions of the gastric antrum also disrupt, but with less regularity.

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