[Value of absorbable stapling in digestive surgery? Experimental study comparing TA metallic stapling, TA absorbable stapling and manual sutures]

Absorbable staples, recently available for TA 55 instrument, has not been yet evaluated in gastro-intestinal surgery. This experimental work was designed to determine the feasibility and the reality of the advantages of the new material: the wound healing process of 3 techniques of intestinal closure (metal staples, Lactomer absorbable staples and polyglactin sutures) were compared. A double Roux en Y loop was performed on 9 dogs: each end was closed by one of these techniques, and recuperated at regular intervals (3 samples by dog). Twelve sutures were examined at 10 post-operative days, 14 at 25 days, and 10 at 130 days. Macroscopic examination showed major inflammatory adhesions around absorbable staples. Two fistulae have complicated absorbable stapling versus 0 with the 2 others techniques. Histologic review showed greater tissue trauma with Lactomer staples than metal staples; intense and prolonged inflammatory reaction was seen around absorbable staples, while metal staples were well tolerated. The difference in design of the 2 staples can explain the differences in the healing process. In spite of the interest for absorbable material, our experimental study shows the present superiority of the metal stapling and prompts improvements of absorbable staples for reliable use in gastro-intestinal surgery.