Surgical Stapling: Principles and Precautions

Abstract

Preserving the viability of the tissues distal to the line of staples is basic to the concept underlying the use of staples to perform a surgical anastomosis. The flow of blood penetrates the double staggered rows of staples that have been applied to the tissues. Unless the tissues are much too thick to be suitable for stapling, one will notice blood oozing through the staple line because the staples assume the configuration of a B when they are fired. Consequently, there is tissue along the staple line that completely escapes being enclosed by the staples, permitting the passage of blood to and beyond the stapled anastomosis. If the tissues being stapled are so thick that compression by the stapling device is likely to produce necrosis, this technique is contraindicated. On the other hand, if the tissues are so thin that the staples cannot provide a firm approximation, bleeding and anastomotic leakage may occur.