A New Approach to the Laparoscopic Double Stapling Technique: Exploration and Reinforcement of Weak Points

Background: Anastomotic leakage is a serious complication in colorectal surgery, often associated with higher morbidity and mortality. Even with advances in medical technology and devices, the rates of anastomotic leakage is not on downward trend. We describe our experimental and clinical validation of our method to overcome the weakness of the double stapling technique, especially the intersecting staple lines. Methods: Experimentally, we conducted double stapled anastomosis with pig small intestines. In order to verify pressure resistance, the anastomosis was tested and compared with that formed by a conventional stapler and a reinforced cartridge preattached to a Neoveil sheet. Additionally, during the anastomosis performed by the circular stapler, both ends of the Neoveil sheet were grasped by forceps, and the Neoveil sheet was pulled tight to fit the anastomotic surface. The burst pressure of the anastomosis was recorded. Clinically, we used a reinforced cartridge for rectal surgery performing a low anterior resection and verified its efficacy and safety. Results: Unlike a conventional stapler, our methods with the use of a reinforced cartridge showed no leakage from the intersecting staple lines. Clinically, our method has been used for 20 patients without complications, including leakage and bleeding. Conclusion: The addition of reinforcing material to the linear stapler should lead to increased strength of the anastomosis. We believe that a double stapling anastomosis that uses our method for the intersection lines provides increased safety and security and thereby should lead to a reduced rate of suture failure after rectal resection.