The healing process of anastomoses of the colon. A comparative study using single, double-layer or stapled anastomosis

Abstract

In spite of modern suture materials and different techniques in colonic anastomoses after resection, leakage is still the most feared complication in colonic surgery. In female pigs of Swedish land breed, standardized 5-cm long colonic resection was performed 10 cm above the peritoneal deflection, using either a single layer of Gambee-stitches (n = 6, Vicryl 4-0), two-layer interrupted stitches (n = 6, Vicryl 4-0) or the intraluminal stapling device (n = 6, ILS Ethicon). After one week, the animals were sacrificed and an anastomotic index was calculated using in vitro x-ray. Also, anastomotic circulation (calculated by the microsphere technique), breaking strength, and histologic evaluation were performed. All animals survived and no leakage was observed. The time to perform the anastomosis was significantly shorter (P less than 0.05) for the stapling device compared with the manual techniques used. The anastomotic index was lower (P less than 0.05) for two rows (0.24) compared with Gambee-stitches (0.38) or stapler anastomoses (0.37). There were no differences in blood flow among the three groups and no differences in breaking strength. Macroscopic investigation revealed mucosal defects in two of the stapled anastomoses and histologic investigation showed small areas of necrosis. The stapling device did not induce any inflammatory reaction. On the other hand, a severe inflammatory reaction was seen when using conventional suture materials. In conclusion, this study shows that a single row of Gambee-stitches is equal to the ILS stapling device when performing colonic anastomoses and these two methods seem to be superior to the two-layer technique.