staple-line reinforcement dan geisler, md, facs, fascrs west penn allegheny health system

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