Comparative Experimental Analysis on Several Anastomotic Techniques of the Colon

Lee, Kang Hong; Yu, Chang Sik; Lee, Han Il; Kim, Wan Soo; Kim, Chang Nam; Choi, Youn; Kang, Gyeong Hoon; Choo, Mee Ra; Park, Sang Kyu; Kim, Jin Cheon

Abstract

BACKGROUND: Although the stapled anastomotic technique has achieved efficacy in gastrointestinal surgery, there are only a few experimental results comparing the physical properties of the anastomotic site, pathologic features of the healing process, and physiologic change after the operation. Moreover, there have been no comparative study among various stapled anastomotic techniques. The purpose of this study was to evaluate the safety of various stapled anastomotic techniques by comparing the physical properties of the anastomotic site, pathologic features of the healing process and physiologic change observed for the classical hand-sewn anastomotic technique with those observed for various stapled anastomotic techniques in the normal porcine colon and rectum.
METHODS
Twelve male pigs were grouped into 4 according to the anastomotic techniques; standard Albert-Lembert two-layer hand-sewn anastomosis, stapled end-to-end anastomosis, stapled end-to-side anastomosis, and stapled side-to-side anastomosis. Each anastomotic technique was applied at 3 sites (ascending colon, transverse colon, and rectum). Groups of animals underwent a second surgery on the 4th week postoperatively, and the anastomotic properties were assessed with respect to the first day of defecation, bursting pressure, tensile strength, gross scar formation, microscopic inflammatory cell infiltration, telangiectasia, lymphangiectasia, foreign-body reaction, granulation and fibrosis. RESULTS: No significant difference among the respective anastomotic techniques was found with respect to the first day of defecation, bursting pressure, tensile strength, microscopic inflammatory cell infiltration, telangiectasia, and lymphangiectasia. However, more scar formation, foreign-body reaction, granulation and fibrosis were observed in the hand-sewn anastomosis. There was no significant difference among the groups of various stapled anastomotic techniques.
CONCLUSION
According to this animal study, various stapled anastomoses were superior to the standard Albert-Lembert two-layer hand-sewn anastomosis with less scar formation, foreign-body reaction,granulation and fibrosis. In colorectal surgery, various stapled anastomotic techniques can be safely applied in accordance with the respective purpose and the anatomical characteristics.