US20160310143A1 - Support Structures and Methods of Using the Same - Google Patents

Abstract

An apparatus for forming an anastomosis between adjacent intestinal sections of tissue includes an anastomosis device having an anvil and a tubular body portion, wherein the anvil is selectively attachable to the tubular body portion by a shaft; and a support structure for deposition between the intestinal sections of tissue. The support structure includes a body defining an aperture therein for receiving the shaft. The body has an outer terminal edge. The support structure includes at least one layer of expandable material disposed at the outer terminal edge of the body.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS
• The present application is a divisional of U.S. application Ser. No. 13/848,265, filed on Mar. 21, 2013, which is a continuation of U.S. application Ser. No. 13/076,550, filed on Mar. 31, 2011, now U.S. Pat. No. 8,424,742, which is a divisional of U.S. application Ser. No. 11/241,267, filed on Sep. 30, 2005, now U.S. Pat. No. 7,938,307, which claims the benefit of and priority to each of U.S. Provisional Application 60/620,066, filed Oct. 18, 2004, and U.S. Provisional Application 60/620,065, filed Oct. 18, 2004, the entire contents of each of which being incorporated herein by reference.
BACKGROUND
• 1. Technical Field
• The present disclosure relates to support structures and, more particularly, to annular support structures, gaskets and the like for use in conjunction with stapling devices, for reducing occurrences of leaking, bleeding and/or stricture.
• 2. Background of Related Art
• Staples have traditionally been used to replace suturing when joining or anastomosing various body structures, such as, for example, the bowel or bronchus. The surgical stapling devices employed to apply these staples are generally designed to simultaneously cut and seal an extended segment of tissue in a patient, thus vastly reducing the time and risks of such procedures.
• Linear or annular surgical stapling devices are employed by surgeons to sequentially or simultaneously apply one or more linear rows of surgical fasteners, e.g., staples or two-part fasteners, to body tissue for the purpose of joining segments of body tissue together and/or for the creation of anastomoses. Linear surgical stapling devices generally include a pair of jaws or finger-like structures between which body tissue to be joined is placed. When the surgical stapling device is actuated and/or “fired”, firing bars move longitudinally and contact staple drive members in one of the jaws, and surgical staples are pushed through the body tissue and into/against an anvil in the opposite jaw thereby crimping the staples closed. A knife blade may be provided to cut between the rows/lines of staples. Examples of such surgical stapling devices are described in U.S. Pat. Nos. 4,354,628, 5,014,899 and 5,040,715, the entirety of each of which is incorporated herein by reference.
• Annular surgical stapling devices generally include an annular staple cartridge assembly including a plurality of annular rows of staples, typically two, an anvil assembly operatively associated with the annular cartridge assembly, and an annular blade disposed internal of the rows of staples. Examples of such annular surgical stapling devices are described in U.S. Pat. Nos. 5,799,857 and 5,915,616 to Robertson et al., the entirety of each of which is incorporated herein by reference.
• For most procedures, the use of bare staples, with the staples in direct contact with the patient's tissue, is generally acceptable. The integrity of the tissue will normally serve to prevent the staples from tearing out of the tissue and compromising the sealing before healing has occurred. However, in some surgical operations, surgical supports, e.g., meshes, are employed by surgeons to bridge, repair and/or reinforce tissue defects with a patient, especially those occurring in the abdominal wall, chest wall, diaphragm and other musculo-aponeurotic areas of the body. Examples of surgical supports are disclosed in U.S. Pat. Nos. 3,054,406, 3,124,136, 4,347,847, 4,655,221, 4,838,884 and 5,002,551, the entirety of each of which is incorporated herein by reference.
• When the staples are applied in surgical procedures utilizing surgical supports (i.e., reinforcing material), the legs of the staple typically pass from the cartridge jaw through a layer of the surgical support, and through the patient's tissue before encountering the anvil jaw. In an alternative procedure, the legs of the staple typically pass from the cartridge jaw through a first layer of the surgical support, then through the patient's tissue, and finally through a second layer of the surgical support before encountering the anvil jaw. With the staples in place, the stapled tissue is clamped between the layers of the surgical support.
• While the surgical supports described above are used in conjunction with linear surgical stapling devices, the need exists for annular support structure for use in conjunction with annular or circular surgical stapling devices, for example, an end-to-end anastomosis stapler such as a Model “EEA™” instrument available from United States Surgical, a Division of Tyco Health-Care Group, LP, Norwalk, Conn. and disclosed in U.S. Pat. No. 5,392,979 to Green et al. In general, an end-to-end anastomosis stapler typically places an array of staples into the approximated sections of a patient's bowels or other tubular organs. The resulting anastomosis contains an inverted section of bowel which contains numerous “B” shaped staples to maintain a secure connection between the approximated sections of bowel.
• In addition to the use of surgical staples, biological tissue adhesives have been developed for tissue repair and the creation of anastomoses. Generally, biological adhesives bond separated tissues together to aid in the healing process and to enhance the tissue strength. Such adhesives may be used instead of suturing and stapling, for example, in surgical procedures, for the repair of tissue or the creation of anastomoses.
• In addition to the use of biological adhesives, following the formation of the anastomosis, a separate instrument or device is used to apply biological sealants to the outer surface of the anastomosis. Typically, in a separate step, the biological sealants are applied to the outer surface of the anastomosis by spraying on, brushing on, swabbing on, any combinations thereof, or any other method contemplated by those skilled in the art. The biological sealants act to reduce and/or stop the incidents of leakage from the anastomosis.
• One possible side effect of any end-to-end bowel anastomosis is its tendency to stenos over time, which stenosis can decrease the diameter of the lumen over time. Accordingly, the need exists for a surgical support structure which operates in conjunction with any end-to-end anastomosis device and assists in maintaining the lumen of the anastomosed bowel or other tubular organ open over time.
• The application of suitable biocompatible adhesive offers many advantages to the patient and the surgeon alike, such as, for example, the possible reduction in the number of staples used, immediate sealing of the tissue being treated, a strengthening of the anastomosis, and a reduction in the occurrence of bleeding from the blood vessels, leakage through the tissue joint, and stricture. Moreover, use of biocompatible adhesives tends to minimize foreign body reaction and scarring.
• Accordingly, the need exists for an annular support structure which operates in conjunction with any end-to-end, annular or circular stapling device and assists in maintaining the lumen of the anastomosed bowel or other tubular organ patent or open over time.
• A need also exists for an annular support structure which operates in conjunction with any end-to-end, annular or circular stapling device to reduce the trauma suffered by the patient, reduce the instances of leakage, reduce the instances of bleeding, and create a relatively strong bond between adjacent body tissues.
• A need also exists for an annular support structure configured to provide support to the anastomosed tissue, preferably, distally and/or proximally of the staple line.
SUMMARY
• According to an aspect of the present disclosure, an apparatus for forming an anastomosis between adjacent intestinal sections of tissue is provided. The apparatus includes an anastomosis device having an anvil and a tubular body portion, wherein the anvil is selectively attachable to the tubular body portion by a shaft; and a support structure for deposition between the intestinal sections of tissue. The support structure includes a body defining an aperture therein for receiving the shaft. The body has an outer terminal edge. The support structure includes at least one layer of expandable material disposed at the outer terminal edge of the body.
• The at least one layer of expandable material may include a first and a second membrane extending radially outward from the outer terminal edge of the body.
• The aperture may be defined by an inner terminal edge of the body. The inner terminal edge may be disposed radially inward of staple receiving slots of a staple cartridge assembly disposed in the tubular body.
• It is envisioned that each of the first and second membranes is made from a polymeric film, such as, for example, polyethylene. The support structure has an undeployed condition wherein the first and second membranes are rolled-up towards the body, and a deployed condition wherein the first membrane extends in a substantially distal direction from the body and the second membrane extends in a substantially proximal direction from the body.
• The apparatus may further include a rip-cord for expanding the first and second membranes. The rip-cord is rolled-up into each of the first and second membranes when the support structure is in the undeployed condition.
• Each membrane may include a first inner layer and a second outer layer. The second outer layer of each membrane may swell at a rate greater than the first inner layer. The second outer layers of the first and second membranes are made from a hydrogel. The first inner layer of each of the first and second membranes may be constructed from a substantially non-absorbable material. The first inner layer of each of the first and second membranes may be fabricated from a bio-absorbable mesh fabric.
• According to another aspect of the present disclosure, a method of disposing a support structure between adjacent intestinal sections is provided. The method includes the step of providing a circular surgical anastomosis device. The circular surgical anastomosis device includes an anvil assembly having an anvil member and a first shaft; and a tubular body portion having an annular knife operatively disposed therein and a second shaft disposed radially inward of the annular knife, the first shaft of the anvil assembly being selectively attachable to the second shaft of the tubular body.
• The method further includes the steps of inserting the anvil assembly into a first intestinal section; inserting the tubular body portion into a second intestinal section; disposing a support structure between the first intestinal section and the second intestinal section, the support structure having at least one layer of expandable material; approximating the anvil assembly and tubular body portion with one another so that an end portion of the first intestinal section, the support structure, and an end portion of the second intestinal section are disposed between the anvil member and the tubular body portion, the support structure being disposed between the first intestinal section and the second intestinal section; firing the surgical anastomosis device to sever the portions of the first and second intestinal sections disposed radially inward of the annular knife, and to touch the portions of the first and second intestinal sections radially outward of the annular knife against the structure; and expanding the at least one layer of expandable material.
• The anvil assembly may include a first shaft and the tubular body portion includes a second shaft disposed radially inward of the annular knife. Desirably, the first shaft of the anvil member is attachable to the second shaft of the tubular body portion. Accordingly, the method may further include the step of attaching the first shaft of the anvil assembly to the second shaft of the tubular body portion prior to the step of approximating the anvil assembly to the tubular body portion.
• The support structure may include an aperture formed therein. Accordingly, the method may further include the step of inserting one of the first shaft of the anvil assembly and the second shaft of the tubular body portion into the aperture of the support structure prior to the step of attaching the first shaft of the anvil assembly to the second shaft of the tubular body portion.
• The tubular body portion may carry a plurality of surgical staples. The surgical staples may be disposed radially outward of the annular knife. Accordingly, in use, firing the surgical anastomosis device includes deploying the plurality of staples so that the staples penetrate a first interstitial section, the support structure and then a second interstitial section.
• The support structure may include a body and a first and a second membrane extending radially outward from the body. Each of the first and second membranes of the support structure may be made from a polymeric film, such as, for example, polyethylene.
• In use, expanding the at least one layer of expandable material may include deploying the first and second membranes from a rolled-up condition to an expanded condition. In the expanded condition, the first membrane may extend in a substantially distal direction from the body portion of the support structure and the second membrane may extend in a substantially proximal direction from the body portion of the support structure.
• The method may further include the step of pulling on at least one rip-cord to expand the first and second membranes.
• Each membrane of the support structure may include a first inner layer and a second outer layer. Accordingly, expanding the at least one layer may include expanding the second outer layer at a greater rate than the first inner layer. The second outer layer of each membrane of the support structure may swell at a rate greater than the first inner layer.
• The second outer layers of the first and second membranes may be made from a hydrogel. The first inner layer of each of the first and second membranes of the support structure may be constructed from a substantially non-absorbable material. The first inner layer of each of the first and second membranes may be fabricated from a bio-absorbable mesh fabric. The body may be perforated or porous.
• The at least one layer of expandable material may expand upon fluid absorption.
• The body may be fabricated from at least one of a polyglactic material, a glycolide homopolymer, and a synthetic absorbable lactomer 9-1 material. The body may be a mesh or other fabric.
• The body may include a wound treatment material. The wound treatment material is desirably at least one of an adhesive, a sealant, a hemostat, and a medicament.
• The body may be compressible so that the outer terminal edge of the body extends beyond the outer radial surface of the anvil and tubular body portion. Accordingly, the body may be fabricated from foam. The body has a first thickness greater than one quarter of a diameter of the body.
• The support structure has an unhydrated condition wherein the body has a first diameter and a first thickness, and a hydrated condition wherein the body has a second diameter greater than the first diameter and a second thickness greater than the first thickness. The body desirably expands from the first diameter and the first thickness to a second diameter and a second thickness upon application of a fluid thereto.
• The body may be constructed from a first part of a two-part wound treatment material, and the fluid applied thereto is a second part of the two-part wound treatment material.
• According to yet another aspect of the present disclosure, a method of performing a surgical anastomosis procedure is provided. The method includes the steps of providing an anastomosis apparatus having an anvil assembly movably mounted with respect to a tubular body portion; providing a support structure including a body having an outer terminal edge, and an aperture therethrough, the body being compressible; disposing an anvil assembly into a first intestinal section; disposing a distal end portion of the surgical stapling apparatus in a second intestinal section; positioning the support structure on a shaft of the anvil assembly; approximating the anvil assembly and the tubular body portion to capture the body of the support structure between the first intestinal section and the second intestinal section and to compress the body portion therebetween so that the body extends radially beyond the anvil member and the tubular body portion to seal the perimeter of the anastomosis site; and firing the anastomosis apparatus to join the first intestinal section, support structure, and second intestinal section.
• The support structure may have an unhydrated condition wherein the body has a first diameter and a first thickness, and a hydrated condition wherein the body has a second diameter greater than the first diameter and a second thickness greater than the first thickness. The support structure may be pre-mounted onto the shaft of the anvil assembly prior to positioning of the anvil assembly in the first intestinal section. Accordingly, prior to approximating the anvil assembly and the tubular body portion, the method further includes the step of hydrating the support structure to expand the body from the first diameter and the first thickness to a second diameter and a second thickness.
• The body may be constructed from a first part of a two-part wound treatment material, and the fluid applied thereto is a second part of the two-part wound treatment material.
BRIEF DESCRIPTION OF DRAWINGS
• The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the disclosure and, together with a general description of the disclosure given above and the detailed description of the embodiments given below, serve to explain the principles of the disclosure, wherein:
• FIG. 1 is a perspective view of an exemplary annular surgical stapling device;
• FIG. 2 is a perspective view of a support structure in accordance with an embodiment of the present disclosure, shown in an undeployed condition;
• FIG. 3 is a cross-sectional view of the support structure ofFIG. 2, as taken through3-3 ofFIG. 2;
• FIG. 4 is a perspective view of the support structure ofFIGS. 2 and 3, shown in a deployed condition;
• FIG. 5 is a cross-sectional view of the support structure ofFIG. 4, shown in the deployed condition;
• FIG. 6 is a perspective view of the intestinal area of a patient, illustrating a method of positioning the support structure ofFIGS. 2-5 on the anvil rod of the annular stapling device ofFIG. 1;
• FIG. 7 is a schematic perspective view of the intestinal area ofFIG. 6, illustrating the anvil rod mounted to the annular stapling device and having the support structure ofFIGS. 2-5 disposed therebetween;
• FIG. 8 is a longitudinal cross-sectional view illustrating the anvil rod mounted to the annular stapling device within a surgical site and the support structure ofFIGS. 2-5, in an undeployed condition, disposed between the apposed surfaces of the tissue;
• FIG. 9 is a longitudinal cross-sectional view illustrating the anvil rod mounted to the annular stapling device within a surgical site and the support structure ofFIGS. 2-5, in a deployed condition, disposed between the apposed surfaces of the tissue;
• FIG. 10 is a perspective view of an support structure according to an alternate embodiment of the present disclosure;
• FIG. 11 is a cross-sectional view of the support structure ofFIG. 10, as taken through11-11 ofFIG. 10;
• FIG. 12 is an enlarged view of the indicated area of detail ofFIG. 11;
• FIG. 13 is a longitudinal cross-sectional view illustrating the anvil rod mounted to the annular stapling device within a surgical site and the support structure ofFIGS. 10-12, in an undeployed condition, disposed between the apposed surfaces of the tissue;
• FIG. 14 is a longitudinal cross-sectional view illustrating the anvil rod mounted to the annular stapling device within a surgical site and the support structure ofFIGS. 10-12, in a deployed condition, disposed between the apposed surfaces of the tissue;
• FIG. 15 is a perspective view of a support structure according to yet another alternate embodiment of the present disclosure;
• FIG. 16 is a schematic perspective view of an anvil assembly of the annular stapling device ofFIG. 1 including yet another support structure operatively associated therewith and in an unexpanded condition;
• FIG. 17 is a schematic side elevational view of the anvil assembly ofFIG. 16 illustrating the support structure in an expanded condition;
• FIG. 18 is a perspective view of a support structure in accordance with another embodiment of the present disclosure, for use with the annular surgical stapling device ofFIG. 1;
• FIG. 19 is a cross-sectional view of the support structure ofFIG. 18, as taken through19-19 ofFIG. 18;
• FIG. 20 is a longitudinal cross-sectional view of the intestinal area of the patient following placement of the support structure ofFIGS. 18 and 19 and firing of the surgical stapling apparatus;
• FIG. 21 is an enlarged cross-sectional view, of the indicated area of detail ofFIG. 20;
• FIG. 22 is an enlarged cross-sectional view, of the indicated area of detail ofFIG. 20, illustrating the annular support structure in a first condition;
• FIG. 23 is an enlarged cross-sectional view, of the indicated area of detail ofFIG. 20, illustrating the annular support structure in a second condition;
• FIG. 24 is a perspective view of a support structure according to an alternate embodiment of the present disclosure;
• FIG. 25 is a transverse cross-sectional view of the support structure ofFIG. 24, as taken through25-25 ofFIG. 10;
• FIG. 26 is a perspective view of the intestinal area of the patient, illustrating the positioning of the support structure ofFIGS. 24 and 25 between the anvil assembly and the tubular body portion;
• FIG. 27 is a longitudinal cross-sectional view of the intestinal area of the patient illustrating the intestinal sections approximated toward one another to contact the support structure ofFIGS. 24 and 25;
• FIG. 28 is a longitudinal cross-sectional view of the intestinal area of the patient illustrating the intestinal sections approximated toward one another to compress the support structure ofFIGS. 24 and 25 between the intestinal sections;
• FIG. 29 is a side elevational view of an anvil assembly including the support structure ofFIGS. 24 and 25, in an unexpanded condition, operatively secured to the stem thereof; and
• FIG. 30 is a side elevational view of an anvil assembly including the support structure ofFIGS. 24 and 25, in an expanded condition, operatively secured to the stem thereof.
DETAILED DESCRIPTION OF EMBODIMENTS
• Embodiments of the presently disclosed annular adhesive structures will now be described in detail with reference to the drawing figures wherein like reference numerals identify similar or identical elements. As used herein and as is traditional, the term “distal” refers to that portion which is furthest from the user while the term “proximal” refers to that portion which is closest to the user.
• Referring initially toFIG. 1, an annular surgical stapling device, for use with the annular adhesive structures disclosed herein, is generally designated as10.Surgical stapling device10 includes ahandle assembly12 having at least one pivotableactuating handle member14, and an advancingmember16. Extending fromhandle member12, there is provided atubular body portion20 which may be constructed so as to have a curved shape along its length.Body portion20 terminates in astaple cartridge assembly22 which includes a pair of annular arrays ofstaple receiving slots36 having a staple (not shown) disposed in each one ofstaple receiving slots36. Positioned distally ofstaple cartridge assembly22 there is provided ananvil assembly30 including ananvil member26 and ashaft28 operatively associated therewith for removably connectinganvil assembly30 to a distal end portion orconnection member40 of staplingdevice10.
• Staple cartridge assembly22 may be fixedly connected to the distal end oftubular body portion20 or may be configured to concentrically fit within the distal end oftubular body portion20. Typically,staple cartridge assembly22 includes a staple pusher (not shown) including a proximal portion having a generally frusto-conical shape and a distal portion defining two concentric rings of peripherally spaced fingers (not shown), each one of which is received within a respectivestaple receiving slot36.
• Typically, a knife (not shown), substantially in the form of an open cup with the rim thereof defining a knife edge, is disposed withinstaple cartridge assembly22 and mounted to a distal surface of a staple pusher (not shown). The knife edge is disposed radially inward of the pair of annular arrays of staples. Accordingly, in use, as the staple pusher is advanced, the knife is also advanced axially outward.
• Reference may be made to U.S. Pat. No. 5,915,616 to Viola et al., the entire content of which is incorporated herein by reference, for a detailed discussion ofannular stapling device10.
• Turning now toFIGS. 2-9, an annular adhesive or support structure, in accordance with an embodiment of the present disclosure, is generally designated as100.Structure100 includes a washer-like or disk-like body102 including a substantially centrally locatedaperture104 formed therethrough.Structure100 is defined by an outerterminal edge106, an innerterminal edge108 defining the size ofaperture104, anupper surface110, and abottom surface112.
• In one embodiment,structure100 is sized such that whenstructure100 is operatively associated with staplingdevice10, as will be described in greater detail below, outerterminal edge106 extends radially beyond staple retaining pockets36 ofstaple cartridge assembly22. Additionally,aperture104 ofstructure100 is sized to at least receiveshaft28 ofanvil assembly30 therethrough. In another embodiment, the distance between outerterminal edge106 and innerterminal edge108 is substantially equal to a width of a tissue contact surface24 (seeFIG. 1) ofstaple cartridge assembly22.
• It is contemplated thatbody102 ofstructure100 may be fabricated from or include a surgical grade, biocompatible, non-absorbable (i.e., permanent) mesh or material desirably impregnated with an adhesive, sealant and/or other medicament. For example,body102 may be fabricated from “TEFLON”, which is a registered trademark owned by DuPont de Nemours & Co. It is further contemplated thatbody102 may be fabricated from a biocompatible polymeric foam, felt, polytetrafluoroethylene (ePTFE), gelatin, fabric or the like, or any other biocompatible material.
• Non-absorbable materials used forbody102 include, and are not limited to, those that are fabricated from such polymers as polyethylene, polypropylene, nylon, polyethylene terephthalate, polytetrafluoroethylene, polyvinylidene fluoride, and the like. Further non-absorbable materials include and are not limited to stainless steel, titanium and the like.
• In one embodiment,body102 ofstructure100 may be fabricated from a bio-absorbable material which is desirably impregnated with an adhesive, sealant, and/or other medicament (i.e., wound treatment material). Accordingly, in use, the sealant component ofstructure100 functions to retard any bleeding which may occur from the tissue, the adhesive component ofstructure100 functions to secure the approximated tissue together, and the bio-absorbability ofstructure100 allows for the at least a portion ofstructure100 to be absorbed into the body after a predetermined amount of time. For example,structure100 may remain in place in the body for approximately 2-3 weeks in order for the anastomosis to sufficiently heal prior to structure100 being absorbed into the body.
• Bio-absorbable materials used forbody102 ofstructure100 include, and are not limited to, those fabricated from homopolymers, copolymers or blends obtained from one or more monomers selected from the group consisting of glycolide, glycolic acid, lactide, lactic acid, p-dioxanone, α-caprolactone and trimethylene carbonate. Other bio-absorbable materials include and are not limited to, for example, Polyglycolic Acid (PGA) and Polylactic Acid (PLA). In one embodiment,body102 may be fabricated from bio-absorbable felt, ePTFE, gelatin or any other bio-absorbable materials. Illustrative examples of bioabsorbable materials include DEXON™ mesh, absorbable felts, such as POLYSORB™, and foams, such as polyurethane.
• It is envisioned thatbody102 ofstructure100 may be impregnated with a wound treatment material “W” which is a pre-cured adhesive or sealant. The pre-cured sealant or adhesive will react with the moisture and/or heat of the body tissue to thereby activate the sealing and/or adhesive properties of the sealant or adhesive. It is envisioned that the pre-cured sealant or adhesive may be a hydro-gel or the like.
• It is contemplated that the wound treatment material “W” is any material for joining, healing, sealing or otherwise treating tissue. In a preferred embodiment, the wound treatment material is a bio-compatible sealant, including, and not limited, to sealants which cure upon tissue contact, sealants which cure upon exposure to ultraviolet (UV) light, sealants which are two-part systems which are kept isolated from one another and are combined or any combinations thereof. Any known suitable adhesive may be used. In one embodiment, it is contemplated that such sealants and/or adhesives are curable. For example, sealants may have a cure time of from about 10 to 15 seconds may be used. In preferred embodiments, the sealant and/or adhesive is a bioabsorbable and/or bio-resorbable material. In another embodiment, it is contemplated that a sealant and/or adhesive having a cure time of about 30 seconds may be used. It is further envisioned that wound treatment material “W” may be a pre-cured adhesive or sealant.
• In certain preferred embodiments, the wound treatment material comprises a sealant. Such a sealant is desirably a PEG-based material. Examples of classes of materials useful as the sealant and/or adhesive include acrylate or methacrylate functional hydrogels in the presence of a biocompatible photoinitiator, alkyl-cyanoacrylates, isocyanate functional macromers with or without amine functional macromers, succinimidyl ester functional macromers with amine or sulfhydryl functional macromers, epoxy functional macromers with amine functional macromers, mixtures of proteins or polypeptides in the presence of aldehyde crosslinkers, Genipin, or water-soluble carbodiimides, anionic polysaccharides in the presence of polyvalent cations, etc.
• Some specific materials which may be utilized include isocyanate terminated hydrophilic urethane prepolymers derived from organic polyisocyanates and oxyethylene-based diols or polyols, including those disclosed in U.S. Pat. Nos. 6,702,731 and 6,296,607 and U.S. Published Patent Application No. 2004/0068078; alpha-cyanoacrylate based adhesives including those disclosed in U.S. Pat. No. 6,565,840; alkyl ester based cyanoacrylate adhesives including those disclosed in U.S. Pat. No. 6,620,846; adhesives based on biocompatible cross-linked polymers formed from water soluble precursors having electrophilic and nucleophilic groups capable of reacting and cross-linking in situ, including those disclosed in U.S. Pat. No. 6,566,406; two part adhesive systems including those based upon polyalkylene oxide backbones substituted with one or more isocyanate groups in combination with bioabsorbable diamine compounds, or polyalkylene oxide backbones substituted with one or more amine groups in combination with bioabsorbable diisoycanate compounds as disclosed in U.S. Published Patent Application No. 2003/0032734, the contents of which are incorporated by reference herein; and isocyanate terminated hydrophilic urethane prepolymers derived from aromatic diisocyanates and polyols as disclosed in U.S. Published Patent Application No. 2004/0115229, the contents of which are incorporated by reference herein.
• It is envisioned and within the scope of the present disclosure that wound treatment material “W” may include one or a combination of adhesives, hemostats, sealants, or any other tissue or wound-treating material. Surgical biocompatible wound treatment materials “W”, which may be used in accordance with the present disclosure, include adhesives whose function is to attach or hold organs, tissues or structures, sealants to prevent fluid leakage, and hemostats to halt or prevent bleeding. Examples of adhesives which can be employed include protein derived, aldehyde-based adhesive materials, for example, the commercially available albumin/glutaraldehyde materials sold under the trade designation BioGlue™ by Cryolife, Inc., and cyanoacrylate-based materials sold under the trade designations Indermil™ and Derma Bond™ by Tyco Healthcare Group, LP and Ethicon Endosurgery, Inc., respectively. Examples of sealants, which can be employed, include fibrin sealants and collagen-based and synthetic polymer-based tissue sealants. Examples of commercially available sealants are synthetic polyethylene glycol-based, hydrogel materials sold under the trade designation CoSeal™ by Cohesion Technologies and Baxter International, Inc. Examples of hemostat materials, which can be employed, include fibrin-based, collagen-based, oxidized regenerated cellulose-based and gelatin-based topical hemostats. Examples of commercially available hemostat materials are fibrinogen-thrombin combination materials sold under the trade designations CoStasis™ by Tyco Healthcare Group, LP, and Tisseel™ sold by Baxter International, Inc. Hemostats herein include astringents, e.g., aluminum sulfate, and coagulants.
• The medicament may include one or more medically and/or surgically useful substances such as drugs, enzymes, growth factors, peptides, proteins, dyes, diagnostic agents or hemostasis agents, monoclonal antibodies, or any other pharmaceutical used in the prevention of stenosis. The medicament may be disposed onstructure100 or impregnated intostructure100. The medicament may include one or more medically and/or surgically useful substances such as drugs, enzymes, growth factors, peptides, proteins, dyes, diagnostic agents or hemostasis agents, monoclonal antibodies, or any other pharmaceutical used in the prevention of stenosis.
• Wound treatment material “W” may include visco-elastic film forming materials, cross-linking reactive agents, and energy curable adhesives. It is envisioned that wound treatment material “W”, and in particular, adhesive may be cured with the application of water and/or glycerin thereto. In this manner, the water and/or glycerin cure the adhesive and hydrate the wound.
• It is further contemplated that wound treatment material “W” may include, for example, compositions and/or compounds which accelerate or beneficially modify the healing process when particles of the composition and/or compound are applied to or exposed to a surgical repair site. For example, the wound treatment material “W” may be a therapeutic agent which will be deposited at the repair site. The therapeutic agent can be chosen for its antimicrobial properties, capability for promoting repair or reconstruction and/or new tissue growth. Antimicrobial agents such as broad spectrum antibiotic (gentamycin sulfate, erythromycin or derivatized glycopeptides) which are slowly released into the tissue can be applied in this manner to aid in combating clinical and sub-clinical infections in a tissue repair site. To promote repair and/or tissue growth, wound treatment material “W” may include one or several growth promoting factors, e.g., fibroblast growth factor, bone growth factor, epidermal growth factor, platelet derived growth factor, macrophage derived growth factor, alveolar derived growth factor, monocyte derived growth factor, magainin, and so forth. Some therapeutic indications are: glycerol with tissue or kidney plasminogen activator to cause thrombosis, superoxide dimutase to scavenge tissue damaging free radicals, tumor necrosis factor for cancer therapy or colony stimulating factor and interferon, interleukin-2 or other lymphokine to enhance the immune system.
• In one embodiment, it is contemplated thatbody102 ofstructure100 may be impregnated with a first component of a two-part adhesive and that the staples, retained instaple receiving slots36 ofstaple cartridge assembly22, may be coated with a second component (e.g., a reactant) of the two-part adhesive. In this manner, the first component of the adhesive is activated when the staples penetrate and capturebody102 ofstructure100 during the firing sequence ofsurgical stapling device10, and the two components of the adhesive contact one another.
• As seen inFIGS. 2-9, in an embodimentannular support structure100 includes at least one, preferably a pair of drapes, skirts ormembranes140,142 (e.g., afirst membrane140 and a second membrane142) extending from outerterminal edge106 ofbody102. Desirably,membranes140,142 are fabricated from a polymeric or plastic film including and not limited to polyethylene and the like. Eachmembrane140,142 includes a first orouter surface140a,142a, respectively, and a second orinner surface140b,142b, respectively.
• As seen inFIGS. 2 and 3,membranes140,142 have a first, undeployed condition whereinmembranes140,142 are rolled-up towardsbody102. Desirably,membranes140,142 are rolled under in a direction toward the first orouter surfaces140a,142athereof, as indicated by arrows “A” ofFIG. 3. As seen inFIGS. 4 and 5,membranes140,142 have a second, deployed condition whereinmembranes140,142 are unrolled or unfurled to extend in a substantially parallel orientation with respect to the central “X” axis. As will be described in greater detail below,first membrane140 is unrolled in a first direction, preferably in a distal direction (e.g., in a direction substantially orthogonal toupper surface110 of body102), andsecond membrane142 is unrolled in a second direction, preferably in a proximal direction (e.g., in a direction substantially orthogonal tolower surface112 of body102).
• As seen inFIGS. 2 and 3,support structure100 desirably includes a rip-cord ortether144,146 rolled-up intomembranes140,142. Rip-cords144,146 include free ends144a,146awhich extend frommembranes140,142 whenmembranes140,142 are in the rolled-up condition. In this manner, as will be described in greater detail below, as rip-cords144,146 are pulled, desirably in a distal direction (e.g., orthogonal toupper surface110 of body102) and a proximal direction (e.g., orthogonal tolower surface112 of body102),membranes140,142 are un-rolled or un-furled accordingly.
• In one embodiment, it is envisioned thatbody102 ofsupport structure100 is formed of a foam material overmolded onto a relatively thin flexible material or film making up membranes orsleeves140,142. Desirably, when un-rolled or un-furled, eachmembrane140,142 extends approximately 2.0 cm frombody102. In other words, when un-rolled or un-furled,first membrane140 extends frombody102 by approximately 2.0 cm fromupper surface110 ofbody102, andsecond membrane142 extends frombody102 approximately 2.0 cm fromlower surface112 ofbody102.
• Turning now toFIGS. 6-9, there is illustrated the use ofsurgical stapling device10 andsupport structure100 in an anastomosis procedure to effect joining ofintestinal sections66 and68. The anastomosis procedure is typically performed using minimally invasive surgical techniques including laparoscopic means and instrumentation. At the point in the procedure shown inFIG. 6, a diseased intestinal section has been previously removed,anvil assembly30 has been introduced to the operative site either through a surgical incision or trans-anally and positioned withinintestinal section68, andtubular body portion20 ofsurgical stapling device10 has been inserted trans-anally intointestinal section66.Intestinal sections66 and68 are also shown temporarily secured about their respective components (e.g.,shaft28 ofanvil assembly30, and the distal end of tubular body portion20) by conventional means such as a purse string suture “P”.
• Annular support structure100 is then placed ontoshaft28 ofanvil assembly30 prior to the coupling ofanvil assembly30 to the distal end oftubular body portion20. In particular,shaft28 ofanvil assembly30 is inserted intoaperture104 ofbody portion102. Following positioning ofstructure100 ontoshaft28 ofanvil assembly30, the surgeonmaneuvers anvil assembly30 until the proximal end ofshaft28 is inserted into the distal end oftubular body portion20 ofsurgical stapling device10, wherein the mounting structure (not shown) within the distal end oftubular body portion20 engagesshaft28 to effect the mounting.
• Thereafter, as seen inFIG. 8,anvil assembly30 andtubular body portion20 are approximated to approximateintestinal sections66,68 andcapture body102 ofannular support structure100 therebetween. Withbody102 captured betweenintestinal sections66,68, as seen inFIG. 9,membranes140,142 are deployed (i.e., un-rolled or un-furled) as described above. In particular,first membrane140 is un-rolled or un-furled in a distal direction, as indicated by arrow “B”, so as to over-lieintestinal section68, andsecond membrane142 is un-rolled or un-furled in a proximal direction, as indicated by arrow “C”, so as to over-lieintestinal section66. Desirably, first andsecond membranes140,142 are un-rolled or un-furled by pulling on rip-cords144,146 in a distal or proximal direction, as necessary.
• Membranes140,142 extend a predetermined distance overintestinal sections66 and68 (e.g., approximately 2 cm). When un-rolled or un-furled,membranes140,142 will adhere to the surface ofintestinal sections66,68.Membranes140 and142 function to inhibit leakage from the anastomosis site and/or function to strengthen or reinforceintestinal sections66,68. Withmembranes140,142 deployed, as seen inFIG. 15,surgical stapling device10 may be fired thereby staplingintestinal sections66,68 to one another and cutting the portion of tissue andstructure100 disposed radially inward of the knife, to complete the anastomosis.
• Turning now toFIGS. 10-14,annular support structure100 includes at least one, preferably a pair ofmembranes150,152 (e.g., afirst membrane150 and a second membrane152) extending fromouter edge106 ofbody102. Eachmembrane150 and152 includes two layers, aninner layer150a,152a, respectively, and anouter layer150b,152b, respectively. Desirably, the materials selected for the construction ofmembranes150,152 swell at different rates when in the presence of moisture or fluid. In this manner,membranes150,152 will tend to bend or curl about the layer having the relatively slower rate of fluid swelling or fluid absorption. In this manner,support structure100 has a first undeployed condition in whichmembranes150,152 extend substantially radially outward frombody102, and a second deployed condition in whichmembranes150,152 are substantially aligned with the central “X” axis ofbody102.
• In accordance with one embodiment, it is envisioned thatinner layer150a,152aofmembranes150,152 are constructed from a substantially non-absorbable (i.e., does not absorb moisture therein) or non-expanding (i.e., static) material, such as, for example, a bio-absorbable mesh fabricated from polyglycolic acid, sold under the tradename DEXON′, available from Tyco Healthcare Group LP, Norwalk, Conn. It is also envisioned thatouter layer150b,152bofmembranes150,152 are constructed from an absorbable or expanding (i.e., dynamic) material, such as, for example, hydrogel and the like.
• Desirably, eachmembrane150 and152 includes a hydrogelouter layer150b,152blaminated to a bio-absorbable meshinner layer150a,152a. Furthermore,support structure100 includes afoam body102 laminated over a pair of duallayered membranes150,152. While eachmembrane150,152 desirably includes a pair of layers, it is envisioned and within the scope of the present disclosure formembranes150,152 to include any number of layers.
• Accordingly, with reference toFIG. 12, the difference in material properties betweeninner layers150a,152aandouter layers150b,152bofmembranes150,152cause membranes150,152 to curl or bend from the undeployed condition, whereinmembranes150,152 extend in a substantially radial direction, to a deployed condition, whereinmembranes150,152 extend in a direction substantially parallel to the central “X” axis (as shown in phantom inFIG. 12).
• Turning now toFIGS. 13 and 14, there is illustrated the use ofsurgical stapling device10 andsupport structure100 includingmembranes150,152 in an anastomosis procedure to effect joining ofintestinal sections66 and68. At the point in the procedure shown inFIG. 13,anvil assembly30 andtubular body portion20 are shown approximated to one another to capturebody102 ofannular support structure100 betweenintestinal sections66 and68, whereinintestinal section66 and68 were previously secured about their respective components (e.g.,shaft28 ofanvil assembly30, and the distal end of tubular body portion20) by conventional means such as a purse string suture “P”,annular support structure100 was positioned betweenintestinal sections66 and68, andanvil assembly30 was coupled to the distal end oftubular body portion20.
• Withbody portion102 ofsupport structure100 captured betweenintestinal sections66,68, as seen inFIGS. 13 and 14,membranes150,152 begin to deploy (i.e., curl or bend from the substantially radially extended orientation to the orientation substantially parallel with the central “X” axis) as described above. In particular, asouter layers150b,152bof first andsecond membranes150,152 absorb fluid and swell (i.e., expand), first andsecond membranes150,152 curl or bend to the side ofmembrane150,152 which swells or expands at a rate slower, i.e., towardinner layers150a,152a. Asmembranes150,152 are deployed, as indicated by arrow “B”,first membrane150 over-liesintestinal section68, andsecond membrane152 over-liesintestinal section66, as indicated by arrow “C”.
• Desirably,membranes150,152 extend a predetermined distance overintestinal sections66 and68 (e.g., approximately 2 cm). Accordingly, when deployed,membranes150,152 will adhere to the surface ofintestinal sections66,68.Membranes150,152 function to inhibit leakage from the anastomosis site and/or function to strengthen or reinforceintestinal sections66,68. Withmembranes150,152 deployed, as seen inFIG. 14,surgical stapling device10 may be fired thereby staplingintestinal sections66,68 to one another and cutting the portion of tissue andstructure100 disposed radially inward of the knife, to complete the anastomosis.
• As seen inFIG. 15,annular support structure100 includes a series ofribs156,158 provided on and/or in eachmembrane150,152, respectively. Desirably,ribs156,158 extend radially around the perimeter or circumference ofmembranes150,152.Ribs156,158 are substantially radially oriented.
• Ribs156,158 are fabricated from a shape memory material, alloy or the like, preferably, NITINOL™ and the like. It is further envisioned thatribs156,158 may be fabricated from a bio-absorbable material.
• Ribs156,158 have a memorized shape which is oriented substantially parallel to the central “X” axis ofsupport structure100. In this manner,support structure100 has a first or un-deployed condition in whichribs156,158 are in a biased rolled-up condition andmembranes150,152 are also rolled-up, and a second or deployed condition in whichribs156,158 are in their memorized shape or condition andmembranes150,152 are extended.
• In use, with support structure in an un-deployed condition,support structure100 is positioned inshaft28 ofanvil assembly30. Withsupport structure100 so positioned,support structure100 is deployed whenribs156,158 return to their memorized conditions. In particular, the return ofribs156,158 to their memorized conditions extendsmembranes150,152 overintestinal sections66 and68 and/or in a direction substantially parallel to the central “X” axis.
• Turning now toFIGS. 18-28, a support structure in accordance with an alternate embodiment is generally designated as200.Support structure200 is substantially similar to supportstructure100 and will only be described in detail to the extent necessary to identify differences in construction and operation.
• As seen inFIGS. 18 and 19,body202 ofsupport structure200 includes a plurality ofpores214 extending therethrough. Desirably, pores214 are substantially parallel with the longitudinal “X” axis ofbody202.Pores214 allow for healing to take place between a pair of apposed tissue surfaces. Additionally, sincepores214 are substantially parallel to the longitudinal “X” axis, leakage of fluid from the anastomotic site is reduced. Whilebody202 has been shown and described as includingpores214, it is envisioned and within the scope of the present disclosure thatbody202 may be perforated or may be constructed from a porous material.
• With continued reference toFIGS. 18 and 19,support structure200 includes a rim orlayer220 of fluid expanding or water-swellable material, e.g., a hydrogel, disposed around outerterminal edge206 ofbody202. Hydrogels contemplated forsupport structure200 are identified in U.S. Pat. No. 5,505,952 to Jiang et al., the entire content of which is incorporated herein by reference.
• Turning now toFIGS. 20-23, there is illustrated the use ofsupport structure200 in an anastomosis procedure to effect joining ofintestinal sections66 and68. The anastomosis procedure is typically performed using minimally invasive surgical techniques including laparoscopic means and instrumentation. At the point in the procedure shown inFIG. 20,support structure200 has been placed ontoshaft28 ofanvil assembly30, theanvil assembly30 has been coupled to the distal end oftubular body portion20 ofsurgical stapling device10, andsurgical stapling device10 has been fired thereby staplingintestinal sections66,68 to one another and cutting the portion of tissue andsupport structure200 disposed radially inward of the knife, to complete the anastomosis.
• As seen inFIG. 21,pores214 ofbody202 allow for in-growth ofintestinal sections66,68 therein thereby improving the healing process. In particular, pores214 ofbody202 reduce the time required forintestinal sections66,68 to contact one another during the healing process. For example, depending on the size ofpores214 ofbody202,intestinal sections66,68 may contact one another immediately following the firing ofsurgical stapling device10, or pores214 ofbody202 define channels into whichintestinal sections66,68 may grow and come into contact with one another over time.
• As seen inFIG. 22, initially, following placement ofsupport structure200 into position betweenintestinal sections66,68 and firing ofsurgical stapling device10,rim220 ofsupport structure200 is in a first or unexpanded (i.e., un-swelled) condition. Subsequently, as seen inFIG. 23, withsupport structure200 in position betweenintestinal sections66,68,rim220 thereof begins to absorb moisture from the surrounding environment (e.g., water, saline, blood, etc.) and expand to a second or swelled condition. In one method, it is envisioned that fluid may be dispensed onto the anastomosis site, especially ontorim220 ofsupport structure200 in order to cause expanding and/or swelling ofrim220.
• As seen inFIG. 23, asrim220 ofsupport structure200 swells or expands, the radial gap “G” betweenintestinal sections66,68 fills. Accordingly,rim220, when in the swelled or expanded condition acts as a seal, dam, stopper, barrier or the like to inhibit and/or prevent the leakage of the contents of the bowel into the abdominal region of the patient. In other words, the swelling ofrim220 results in the formation of a gasket-like seal around the outside of the anastomosis.
• Turning now toFIGS. 24-28, a support structure, in accordance with an alternate embodiment of the present disclosure, is generally designated as300. As seen inFIGS. 24 and 25,body302 ofsupport structure300 may be formed entirely of resilient compressible foam or sponge-like material fabricated from a bio-absorable material or any other bio-compatible material disclosed above with regard to supportstructure100. Desirably, as seen inFIG. 25,body302 ofsupport structure300 has an initial height or thickness “T1” (e.g., the height or thickness whenbody302 is fully expanded). Desirably,body302 has a diameter “D” which is at least equal to a diameter oftubular body portion20 and/oranvil member26. Most desirably, the diameter “D” of body portion ofsupport structure300 is greater than the diameters oftubular body20 and/oranvil member26. Desirably, thickness “T1” is greater than a quarter of the diameter “D”, when in the initial uncompressed condition.
• Turning now toFIGS. 26-28, there is illustrated the use ofsurgical stapling device10 andsupport structure300 in an anastomosis procedure to effect joining ofintestinal sections66 and68. As seen inFIGS. 27 and 28, with asupport structure300 positioned onshaft28 ofanvil assembly30 and disposed betweenintestinal sections66,68, asanvil assembly30 andtubular body portion20 are approximated,body302 ofsupport structure300 is compressed therebetween. In particular, as seen inFIG. 27, prior to complete approximation,body302 ofsupport structure300 is uncompressed and desirably extends radially beyond the outer terminal edges oftubular body portion20 and/oranvil member26. In particular,body302 ofsupport structure300 has a thickness substantially equal to “T1”. Thereafter, upon complete approximation,body302 ofsupport structure300, in the region disposed betweentubular body portion20 andanvil member26, is compressed therebetween to a thickness “T2”. Accordingly, the portion ofsupport structure300 disposed radially outward oftubular body portion20 andanvil member26 remains substantially uncompressed (e.g., having a thickness approximately equal to “T1”) thereby filling and/or sealing the radial gap “G” betweenintestinal sections66,68.
• In addition to reducing leakage from the anastomosis site, due to the compressible nature ofbody302 ofsupport300, thebody302 is capable of filling any voids or recesses which may exist in the surface ofintestinal sections66,68.
• Following the approximation ofanvil assembly30 andtubular body portion20, to approximateintestinal sections66,68 andcapture body302 ofsupport structure300 therebetween,surgical stapling device10 is fired thereby staplingintestinal sections66,68 to one another and cutting the portion of tissue andsupport structure300 disposed radially inward of the knife, to complete the anastomosis.
• As seen inFIG. 29,support structure300 may have an unexpanded (e.g., collapsed or un-hydrated condition) in whichbody302 ofsupport structure300 has a first diameter “D1” and a first thickness “T1”. Additionally, as seen inFIGS. 29 and 30,anvil assembly30 includes a network ofchannels28aformed inshaft28 which are configured and arranged to dispense fluid onto and/or direct fluid intobody302 ofsupport structure300. Whilechannels28ahave been shown and described, any structure for delivering fluid tobody302 ofsupport structure300 is contemplated by the present disclosure.
• As seen inFIG. 30, fluid “F” is delivered tobody302 ofsupport structure300 thereby causingbody302 ofsupport structure300 to expand radially and longitudinally. In other words, the application of fluid “F” tobody302 ofsupport structure300 causesbody302 ofsupport structure300 to expand and hydrate. In the expanded condition,body302 ofsupport structure300 has a second diameter “D2”, larger than first diameter “D1”, and a second thickness “T2”, larger than first thickness “T1”.
• In use, withsupport structure300 in the un-expanded condition,anvil assembly30 is introduced into the surgical site as described above. Following connection ofanvil assembly30 to the distal end oftubular body portion20, fluid “F” is delivered tobody302 ofsupport structure300, thereby causingsupport structure300 to expand. Following expansion ofsupport structure300, the surgical procedure is continued as described above.
• It is envisioned and within the scope of the present disclosure that the fluid “F” may be a cross-linker or other substance which is reactive with the foam ofbody302 ofsupport structure300 to thereby form or create asupport structure300 of wound treatment material (e.g., adhesive, sealant, hemostat, medicament, etc.). It is contemplated thatbody302 ofsupport structure300 may be a foam made from a first part of a two-part wound treatment material, and fluid “F” may include a second part of the two-part wound treatment material. In this manner, the wound treatment material is formed upon interaction of fluid “F” withbody302 ofsupport structure300.
• From the foregoing, it will be appreciated that the support structures of the present disclosure function to strengthen the anastomosis and reduce the occurrence of bleeding, leaking and stricture. It is also to be appreciated that the support structures of the present disclosure may be utilized in a number of other applications and is not limited solely to bowel or bronchus anastomosis.
• While several particular forms of the support structures have been illustrated and described, it will also be apparent that various modifications can be made without departing from the spirit and scope of the present disclosure. For example, it is envisioned and within the scope of the present disclosure for an ultraviolet light activated adhesive to be used in connection with any of the support structures described above. In use, either prior to or following firing ofsurgical stapling device10, the support structure is irradiated with UV light to thereby activate the adhesive thereof.
• It is further contemplated that each of the support structures described herein may be used with an annular surgical anastomosing device, not including any staples for securing tissue together, which is capable of approximating, adhering and cutting tissue.
• Thus, it should be understood that various changes in form, detail and application of the support structures of the present disclosure may be made without departing from the spirit and scope of the present disclosure.

Claims (20)

1. (canceled)

2. An apparatus for forming an anastomosis between adjacent intestinal sections of tissue, the apparatus comprising:

a surgical stapling instrument including a staple cartridge assembly and an anvil assembly operatively associated with the staple cartridge assembly; and

a support structure including:

a body defined by an inner terminal edge and an outer terminal edge, the inner terminal edge defining an aperture centered about a central axis; and

at least one membrane extending from the outer terminal edge of the body, the at least one membrane including a plurality of ribs fabricated from a shape memory material.

3. The apparatus according toclaim 2, wherein the at least one membrane is a polymeric film.

4. The apparatus according toclaim 2, wherein the at least one membrane extends completely around the outer terminal edge of the body.

5. The apparatus according toclaim 4, wherein the plurality of ribs extend radially around the central axis of the body in spaced relation relative to each other.

6. The apparatus according toclaim 2, wherein the at least one membrane has an undeployed condition and a deployed condition, and the plurality of ribs of the at least one membrane have a memorized shape that corresponds with the deployed condition.

7. The apparatus according toclaim 6, wherein, in the undeployed condition, the at least one membrane is rolled towards the body and, in the deployed condition, the at least one membrane is unrolled and extends away from the body.

8. The apparatus according toclaim 6, wherein the memorized shape is oriented substantially parallel to the central axis of the body such that, in the deployed condition, the at least one membrane extends substantially parallel to the central axis.

9. The apparatus according toclaim 2, wherein the at least one membrane includes first and second membranes.

10. The apparatus according toclaim 9, wherein the first and second membranes overlap one another.

11. The apparatus according toclaim 9, wherein, the first and second membranes each have an undeployed condition and a deployed condition, and, in the deployed condition:

the first membrane extends in a first direction from the body; and

the second membrane extends in a second direction from the body, opposite the first direction.

12. A support structure for deposition between adjacent intestinal sections of tissue, the support structure comprising:

a body defined by an inner terminal edge and an outer terminal edge, the inner terminal edge defining an aperture centered about a central axis; and

at least one membrane extending from the outer terminal edge of the body, the at least one membrane including a plurality of ribs fabricated from a shape memory material.

13. The annular support structure according toclaim 12, wherein the at least one membrane is a polymeric film.

14. The annular support structure according toclaim 12, wherein the at least one membrane extends completely around the outer terminal edge of the body.

15. The annular support structure according toclaim 14, wherein the plurality of ribs extend radially around the central axis of the body in spaced relation relative to each other.

16. The annular support structure according toclaim 12, wherein the at least one membrane has an undeployed condition and a deployed condition, and the plurality of ribs of the at least one membrane have a memorized shape that corresponds with the deployed condition.

17. The annular support structure according toclaim 16, wherein, in the undeployed condition, the at least one membrane is rolled towards the body and, in the deployed condition, the at least one membrane is unrolled and extends away from the body.

18. The annular support structure according toclaim 16, wherein the memorized shape is oriented substantially parallel to the central axis of the body such that, in the deployed condition, the at least one membrane extends substantially parallel to the central axis.

19. A support structure for deposition between adjacent intestinal sections of tissue, the support structure comprising:

a body including an outer terminal edge; and

first and second membranes each extending completely around the outer terminal edge of the body, each of the first and second membranes including a plurality of ribs extending radially around a central axis of the body.

20. The support structure accordingclaim 19, wherein the plurality of ribs of the first and second membranes are fabricated from a shape memory material having a memorized shape.

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