Analysis of The Causes of Abnormal Staple Formation in Surgical Staplers

In surgical procedures, the quality of staple formation is directly related to surgical outcomes and patient prognosis. Incomplete staple formation, abnormal staple height, missing staples, and broken staples can not only lead to anastomotic bleeding or leakage, but in severe cases may also result in anastomotic failure, increasing the risk of reoperation.

This article provides a clear overview of the key factors influencing the rate of poor staple formation in surgical staplers—primarily falling into four major categories—as well as common types of defects and quick identification methods, offering practical guidance for clinical application.

Tissue Factors

Excessive tissue thickness may result in increased staple height and poor apposition, whereas overly thin tissue may lead to loose staples or tissue injury. Uneven thickness can create weak points and increase the risk of leakage. Increased tissue hardness, fibrosis, calcification, or the presence of foreign bodies can hinder proper staple formation and increase the likelihood of staple breakage. Edematous, inflamed, or ischemic tissues have poor healing capacity, and excessive tension may cause staple deformation or tissue tearing.

Device and Consumable Factors

The design, quality, and compatibility of devices and consumables directly affect staple formation quality. Mismatch between cartridge height and tissue thickness, incompatibility between the cartridge and stapler, poor material properties or tolerances of staples, misalignment between the anvil and cutting blade, as well as insufficient battery power or sensor malfunction in powered devices can all lead to defective staple formation.

Technical Factors

Surgical technique is another key factor. Incorrect assembly, inadequate closure, overly rapid firing, improper angulation, intraoperative interference by foreign materials, and repeated firing may all result in poor staple formation.

Device Condition and Maintenance Factors

For reusable instruments, wear and tear, spring failure, joint loosening, and inadequate cleaning or lubrication can reduce staple formation precision and negatively impact surgical outcomes.

Clinical Manifestations and Common Types of Defects

Defective staple formation commonly presents as C-shaped staples, inconsistent staple height, missing staples, broken staples, or bent staple legs, as well as bleeding or looseness along the staple line. Postoperative anastomotic leakage is often associated with intraoperative poor staple formation. Common defect types include incomplete staple formation, abnormal staple height, bent staple legs, broken staples, and missing staples. These issues may arise from factors such as tissue thickness or hardness, cartridge selection, firing technique, and device condition, and may lead to risks including bleeding, leakage, localized seepage, tissue injury, or anastomotic failure.

Key Components and Rapid Assessment

Key components include the cartridge, anvil, and the staple pusher or firing mechanism. Rapid assessment of staple formation quality involves checking whether the staples form a standard B-shape, whether the staple height is uniform, whether there is any misalignment or missing staples, and whether the staple line is closely apposed.

Strategies to Reduce the Rate of Defective Staple Formation

To reduce the rate of defective staple formation, it is essential to accurately assess tissue thickness, hardness, edema, and tension; select an appropriately matched cartridge height; standardize closure and firing techniques; and ensure that disposable consumables are intact, while reusable instruments are fully functional, properly cleaned, and adequately lubricated.