His post-operative management was complicated by high ileostomy output which did not readily slow with multiple modalities to control gastrointestinal loss. The patient required delayed abdominal wound closure due to recurring intra-abdominal sepsis. His hospital course was complicated by recurrent ileostomy necrosis and futile wound healing, resulting in colonic suture breakdown with recurrent fecal peritonitis and septic shock, acute renal failure requiring dialysis, acute respiratory failure requiring trach and right upper extremity deep venous thrombosis. A contour stapler was then used instead of the powered stapler for segmental transection of the ascending colon. Repeated attempts to override using the manual handle failed and it took over 10 min to separate the stapler sides. The stapler abruptly froze a sound went off and it became locked. Midway through, another attempt to transect the proximal part of ascending colon using powered Endo-GIA stapler failed (Fig. The patient was taken back to the operating room for exploratory laparotomy and repair of the dehiscence. A few days later, dehiscence of the staple line on the ascending colon occurred. All the mesentery between the two transected points was taken down using the ligature. The cecum was transected using a 75 mm GIA blue load. The proximal part of the cecum was freed from peritoneal attachment. Approximately 7 cm proximal to the ileocecal valve, the terminal ileum was transected using a 55 mm GIA blue load. During the procedure, mild hyperemia of the appendix was noted. Patient was prepared and positioned for surgery in supine position. Patient was promptly taken to the operating room for an exploratory laparotomy, ileocecotomy, appendectomy, drainage of abscess and ileostomy. Computed tomography (CT) Imaging was concerning for ruptured appendicitis and clinical exam was consistent with peritonitis and sepsis. ![]() Physical exam revealed non-radiating pain localized to the right lower quadrant absent of alleviating or exacerbating factors and without associated symptoms. © 2017 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.A 72-year-old man with past medical history including hypertension, chronic kidney disease, cerebrovascular disease and chronic obstructive pulmonary disease presented to the emergency department with altered mental status and abdominal pain. Our results showed that the Endo GIA™ Reinforced Reload with Tri-Staple™ Technology had higher rates of complete staple formation than the Endo GIA™ with Tri-Staple™ Technology, irrespective of tissue thickness and the presence of a staple-on-staple site. In contrast, the rates of complete formation with the Endo GIA™ Reinforced Reload with Tri-Staple™ Technology were 99.3 ± 1.27% for stomach tissue and 100.0 ± 0.0% for colon tissue. The rates of complete formation with the Endo GIA™ with Tri-Staple™ Technology were 95.6 ± 0.6% for stomach tissue and 95.6 ± 2.3% for colon tissue, which is thinner than stomach tissue. Stapling was performed using a two-stage crossing approach to make a staple-on-staple site. Two types of automatic suturing devices were employed: (i) the Endo GIA™ Reinforced Reload with Tri-Staple™ Technology with a cartridge with the reinforcement material Neoveil™ and (ii) the Endo GIA™ with Tri-Staple™ Technology with no reinforcement material. ![]() The iDrive™ Ultra Powered Stapling System was used to fire the automatic suturing device. These factors are considered to be related to postoperative complications such as anastomosis failure. However, overly thick or thin tissue, displacement of tissue, and the creation of a staple-on-staple site may lead to incomplete staple formation. Automatic suturing devices have been widely used for gastrointestinal anastomosis. Despite the availability of various anastomosis techniques, postoperative anastomotic complications such as anastomosis failure and bleeding develop in some patients.
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