Editing Stapling (section)

== '''Principles of stapling''' ==

* Choose the appropriate staple size for tissue. If too big - excessive staple-line bleeding, or rarely leakage through the intact staple line. If too small - staples won't reach full thickness and won't form correctly, leading to failure and leak.
** It's probably better to use a staple size that is too big rather than too small.
** Sometimes the tissue (for example some re-operative stomachs) are too thick for any stapler, and hand-sewn is the best option
* Staplers from different manufacturers can have subtle differences, despite similar appearances
* 'Rest' the tissue for 15 seconds after fixing the stapler to allow oedema to reduce
* Be careful firing staplers across an existing staple line - the knife can catch on existing staples, pulling them out of place and disrupting. To avoid this, always fire at an angle of at least 45 degree.
* No good data to support or refute oversewing staple lines
* Where possible, test staple lines intra-operatively
* Intra-luminal staple line bleeders can be controlled with sutures or careful cautery