Assessment of reinforcing sutures of double-stapling anastomosis with manual and powered circular staplers in Porcine models

Preventing anastomotic leakage (AL) is crucial in rectal surgery, and several surgical techniques have been proposed to reduce the risk and severity of AL. This study evaluated the burst pressure at the double-stapling anastomosis in a porcine model to provide evidence to support the clinical efficacy of powered circular staplers and anastomotic reinforcing sutures. An experimental study using an ex vivo porcine model was performed to measure burst pressure as an AL test. We compared four groups with and without the placement of reinforcing sutures at the anastomotic site in each model using a powered and manual circular stapler. Four models were created in each of the four groups, for a total of 16 porcine test models. Anastomotic reinforcing sutures with a powered circular stapler improved the burst pressure by approximately 8% (p = 0.996), whereas those performed using a manual circular stapler improved the burst pressure by approximately 45% (p = 0.403). The powered circular stapler with anastomotic reinforcing sutures (n = 4, 28.7 ± 2.3 mmHg) increased burst pressure by about 63% compared to manual circular stapler without anastomotic reinforcing sutures (n = 4, 17.6 ± 1.0 mmHg) (p = 0.048). Our study suggests that the intraluminal pressure at the double-stapling anastomotic site may be improved by using a powered circular stapler or by adding an anastomotic reinforcing suture.