The science of stapling and leaks
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Updated: Aug 20, 2026

The C-seal: A Biofragmentable Drain Protecting the Stapled Colorectal Anastomosis from Leakage
Published on: November 4, 2010
Randal S Baker1, James Foote, Paul Kemmeter
1Michigan Medical Center for Health Excellence, Grand Rapids, MI 49546, USA. rbaker@mmpc.com
Abstract:
Staple-line leaks represent an unwanted, yet seemingly unavoidable, complication of stapling associated with bariatric surgery. Although, "folk legends" abound as to precluding leaks, little has been written based on basic research and understanding of stapling mechanics. This article reviews the history of stapling and discusses the implications of understanding the biomechanics of stapling living tissue. Finally, three leak studies evaluating ways to optimize staple-line strength are presented, and a large bariatric clinical series is reviewed.
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