Abstract:

Many techniques have been analysed to reduce the risk of perioperative anastomotic leakage and bleeding. No specific resection technique with either linear or circular stapling devices has been shown to be superior in preventing these complications. Reinforcement of staple lines with various buttressing materials is a new strategy used to diminish or eliminate anastomotic leaks and haemorrhage. In this chapter, varying reinforcement techniques with different materials are compared. The available literature has been reviewed thoroughly for relevant data regarding stapled reinforcement techniques and minimizing anastomotic leaks and haemorrhage. Reported data show non-absorbable, semi-absorbable, and bioabsorbablematerials available for gastrointestinal (GI) resections. Semi-absorbable xenomaterials (Bovine Pericardial Strips and Bovine Collagen Strips; Shellhigh No-Reaction Vascupatch, Milburn, NJ, USA), non-absorbable expanded polytetrafluoroethylene (ePTFE®; W.L. Gore, Elkton, MD, USA) and absorbable poly (L-lactic acid-coepsilon-caprolactomne) film are compared. Non-absorbable and semi-absorbable materials show many differences. Absorbable polymer membranes demonstrate marked benefits. Staple-line reinforcement used for laparoscopic GI surgery is a relatively new strategy, most probably improving perioperative outcome only if proper buttressing material is used. To decrease anastomotic complications, using an absorbable polymer membrane as staple-line reinforcement material is reliable and efficacious.

Authors:

Esther C.J. Consten. M.D., Ph.D., Michel Gagner, M.D., F.A.C.S., F.R.C.S.C.

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