Purse string placement for staple anastomosis using the end-to-end anastomosis stapling instrument

Area of Science:

• Veterinary Surgery
• Surgical Innovation

Background:

• Technical challenges exist with clamp use for purse-string sutures in end-to-end staple anastomosis.
• Improper suture placement near the bowel edge risks including ischaemic tissue, potentially causing anastomotic dehiscence in canine models.

Purpose of the Study:

• To address technical difficulties in end-to-end staple anastomosis.
• To present an improved purse-string suturing technique to minimize anastomotic complications.

Main Methods:

• Evaluation of clamp-assisted purse-string suture insertion.
• Comparison with hand-sewn purse-string techniques.
• Implementation and assessment of an "over and over" purse-string technique in canine models.

Main Results:

• Hand sewing purse strings can mitigate some clamp-related issues.
• Incorrect suture placement (within millimeters of the cut edge) can lead to ischaemic tissue inclusion.
• Excision of ischaemic tissue and suture reinforcement can protect the anastomosis.

Conclusions:

• An "over and over" purse-string technique is preferred for end-to-end staple anastomosis.
• This technique effectively minimizes the risk of ischaemic tissue inclusion and subsequent anastomotic dehiscence.