# Use of the Staple Line Reinforcement Tool to Reduce the Rate and Completely Avoid Anastomotic Leakage in Functional End-to-End Anastomosis

## TL;DR

This study shows that using a new tool during a specific surgical procedure can completely prevent a dangerous complication called anastomotic leakage.

## Contribution

Demonstrates complete prevention of anastomotic leakage using the ECHELON ENDOPATH® Staple Line Reinforcement tool in functional end-to-end anastomosis.

## Key findings

- No anastomotic leakage occurred in the group using the new staple line reinforcement tool.
- The tool significantly reduced leakage rates for small intestine-colon anastomoses.
- Leakage rates were not significantly different for other anastomosis types.

## Abstract

Background

In our hospital, anastomotic leakage (AL) is observed in approximately 2% of functional end-to-end anastomosis (FEEA) cases annually. It is also usually observed at the staple line of the entry hole closure in several reoperation cases. This study aimed to investigate whether AL would occur in FEEA using a new staple line reinforcement tool, ECHELON ENDOPATH® Staple Line Reinforcement (SLR) (Ethicon, Raritan, NJ, USA).

Methods

A total of 380 patients (400 anastomoses performed from September 2021, when SLR use began, to the end of February 2024) were compared retrospectively, with a total of 459 patients (469 anastomoses performed from April 2019 to August 2021), the same period before SLR was initiated. In the SLR group, ECHELON FLEX® (Ethicon) 60 mm and GST® system (Ethicon) cartridges were used as stapling devices. A p-value of <0.05 was considered statistically significant.

Results

No AL was observed in the SLR group, with a significant difference between the SLR and non-SLR groups (p=0.0021). By anastomotic organ, the AL rate significantly decreased for small intestine-colon anastomosis (p=0.023), but there was no significant difference in small intestine-small intestine anastomosis (p=0.061) or colon-colon anastomosis (p=0.35) between groups.

Conclusion

Reinforcing the staple line using SLR in FEEA may reduce the AL rate. Although AL has not been observed, we will continue to investigate its causes should it occur in the future.