European Surgery

, Volume 51, Issue 1, pp 19–26 | Cite as

Validation of the vulnerable crotch on a side-to-side anastomosis: Observation of the burst process

  • Masahiro KimuraEmail author
  • Satoshi Taniwaki
  • Yasuyuki Shibata
  • Nobuo Ochi
  • Takaya Nagasaki
  • Shuhei Ueno
  • Yuki Eguchi
  • Hiroyuki Asai
original article



The vulnerability of the crotch on a side-to-side anastomosis to leak has been widely recognized. However, countermeasures to prevent leaks from the crotch have not proven to be sufficient.


A side-to-side anastomosis was performed between two intestinal specimens using a linear stapler. We analyzed the burst pressures of anastomoses. Comparison was made in five groups, with different staple heights, presence of Neoveil® (Gunze, Japan), with or without crotch buttressed with nylon. Using an endoscope inserted into the intestinal lumen, we observed the burst process.


We observed a significant difference in the resistance of the crotch to leak between the two types of reinforcement. In all experimental groups, the leak was observed not only on the serosal surface but also from within the lumen. Neoveil® significantly increased the burst pressure (41.4 ± 3.6 vs. 88.8 ± 14.6 mm Hg; p < 0.01). When reinforced with nylon suture, resistance to leak was recognized only in anastomoses with suture reinforcement from within the lumen. Observing from within the intestinal lumen, as the pressure increased, the intestine split along the length of the stapled anastomosis. A leak occurred when the split reached the center of the staple line. In the group using Neoveil® there was no obvious change in the Neoveil® itself with increases in pressure. In the group reinforced with nylon sutures, the crotch of the anastomosis expanded, and the intestine split, leading to a dehiscence and leak.


The efficacy of various crotch reinforcement methods both experimentally and clinically has thus far been in doubt. With our experiment, the mechanism by which leaks occur at the crotch has become clear, giving evidence for the optimal reinforcement method for stapled intestinal anastomoses.


Leak Staple Intestinal lumen Burst process Neoveil® 


Compliance with ethical guidelines

Conflict of interest

M. Kimura, S. Taniwaki, Y. Shibata, N. Ochi, T. Nagasaki, S. Ueno, Y. Eguchi, and H. Asai declare that they have no competing interests.

Ethical standards

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • Masahiro Kimura
    • 1
    Email author
  • Satoshi Taniwaki
    • 1
  • Yasuyuki Shibata
    • 1
  • Nobuo Ochi
    • 1
  • Takaya Nagasaki
    • 1
  • Shuhei Ueno
    • 1
  • Yuki Eguchi
    • 1
  • Hiroyuki Asai
    • 1
  1. 1.Department of SurgeryNagoya City East Medical CenterNagoyaJapan

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