Ex Vivo and Simulation Comparison of Leakage in End-to-End Versus End-to-Side Anastomosed Porcine Large Intestine

Figures

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  Figure 1. Two possible approaches for stapled colorectal anastomosis: (a) end-to-end (EE), (b) end-to-side (ES).

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  Figure 2. Circular staple: (a) launcher, (b) anvil.

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  Figure 3. Prepared specimens, (A) ES, (B) EE, and (C) Control specimens. The locations of the circular stapled anastomoses are shown using red ellipses.

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  Figure 4. Experimental setup for leakage testing: (A) water tank, (B) temperature controller, (C) specimen, (D) adapter and clamp, (E) air input from pump, (F) pressure transducer, (G) load cell.

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  Figure 5. Examples of the three leakage testing groups: (a) EE, (b) ES, (c) Control (before moving it into the water tank).

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  Figure 6. A typical colorectal anastomosis leak testing pressure–time history.

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  Figure 7. Phases of the leakage testing for an EE anastomosis: (a) colonic section before pumping air, (b) section just before the leakage initiation, (c) section at the onset of leakage, (d) section near the end of the test.

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  Figure 8. An example of EE image processing: (a) actual image, (b) corresponding black and white image, and (c) separation of the border into left, right, upper, and lower edges.

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  Figure 9. Single circular staple: (a) actual, (b) simplified model.

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  Figure 10. FEM geometries of (a) one-eighth Control, (b) one-eighth EE anastomosis, and (c) one-half ES anastomosis. Models are not shown on the same scale.

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  Figure 11. FEM meshes of (a) one-eighth Control, (b) one-eighth EE anastomosis, and (c) one-half ES anastomosis. Models are not shown on the same scale.

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  Figure 12. Detail of the meshes used for the staples and the surrounding tissues: (a) EE and (b) ES. Models are not shown on the same scale.