Staple-Line Reinforcement
Dan Geisler, MD, FACS, FASCRSWest Penn Allegheny Health System
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Disclosures
Covidien Consultant
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Staple Line Reinforcement
WHY?
Anastomotic Leak
Staple Line Bleeding
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Staple Line Reinforcement
WHAT?Synthetic, bioabsorbable staple-line
reinforcementCollagen matrixPolyglycolic acid
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Staple Line Reinforcement
WHAT?Gore SeamguardSynovis Staple Line ReinforcementCook biodesign staple line reinforcementCovidien Duet TRS
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GORE SeamguardBioabsorbable Staple Line Reinforcement
• Synthetic Absorbable• Sleeves (“socks”) held by non-absorbable
polyester braided suture• Increases thickness of tissue by up to 0.5mm
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Staple Line Reinforcement
Synovis® Peri-Strips Dry®• Biologic tissue prepared from bovine pericardium
(U.S. cattle)• Strips attached by gel (“glue”)• Increases thickness of tissue by 0.5mm to 1.5mm
Synovis® Peri-Strips Dry® with Veritas® Collagen Matrix• Prepared from dehydrated bovine pericardium (U.S.
cattle)• Similar assembly to Peri-Strips Dry®
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Staple Line Reinforcement
PeriPatch™ Aegis• Processed Bovine Pericardial Staple Line
Reinforcement• Made ONLY for Ethicon staplers
• (ETS/Flex 45 and Echelon 60)• Easier to assemble, but more preparation involved
(pre-soak)• IFU recommends use of 15mm trocar
PeriPatch™ Aegis EQ• Identical in design to PeriPatch™ Aegis, but it is
made from equine pericardium
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Staple Line Reinforcement
DUET Thinnest On the Market
• will increase the thickness of the tissue to be stapled by approximately 0.12mm – 0.18mm
Clear• easily view staple formation
Synthetic Absorbable• Consistent Thickness
Optimal Absorption Profile• Strength During Critical • Wound Healing Time
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Staple Line Reinforcement
WHAT?
11 Covidien | April 19, 2023 | Confidential11 |
Duet Tissue Reinforcement – Absorption Profile
Reinforcement material is a synthetic absorbable film
• prepared from synthetic polyester composed of glycolide, dioxanone and trimethylene carbonate
• Measurable mechanical strength through 14 days
• Absorption should be complete between 90-110 days
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Staple Line Reinforcement
WHEN?High-risk anastomosisBleeding Anastomotic leaks
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DATA?
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Staple Line Reinforcement
Gastric Bypass N = 1073 (568 bovine collagen matrix) Abdominal septic events
• 4% versus 1%• Staple line leakage• Purulent drainage• Abscess
Callery CD, Filiciotto S, Neil KL
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Staple Line Reinforcement
Colorectal Anastomosis N = 117 laparoscopic + open Circular bioabsorbable Seanguard 4 intraoperative leaks
Use of Seamguard may result in a lower incidence of anastomotic leakage
Portillo & Franklin
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Staple Line Reinforcement
Colorectal Anastomosis
“most…need to be accepted and optimized”
“not much experience…further investigation
is needed”
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Staple Line Reinforcement
Seems promising
Preventing leakage + bleeding
More studies are needed