Abstract
Bowel anastomoses are conventionally performed using a handsewn technique or a stapling device. Each has potential benefits and disadvantages. The most clinically significant complications of the bowel anastomosis are anastomotic leakage and stricture formation. The indices of healing and tissue cohesion were compared dynamically over time in 24 dogs randomized to undergo either a standard two-layer handsewn anastomosis or a stapled anastomosis with the Premium CEEATM (United States Surgical Corporation, Norwalk, CT). Animals were sacrificed at 1, 4, 7, and 28 days postoperatively. Each anastomosis was evaluated for anastomotic index, burst pressure, collagen content, and histologic appearance. The anastomotic index was similar on postoperative day (POD) 1, 4, and 7; but on day 28 all handsewn anastomoses had larger diameters than the widest CEEATM anastomosis. Burst pressure was higher in handsewn anastomoses at all intervals. Collagen content tended to be higher on POD 7 in the CEEATM anastomoses. Histological evaluation showed more complete epithelialization and less inflammation in handsewn anastomoses on POD 28. The higher level of collagen in the CEEATM anastomoses on POD 7 may be implicated in the tendency toward stricture formation found with this type of anastomosis. This study demonstrates that the greater speed and ease of the stapled anastomosis is offset by the greater strength, reduced tendency to stricture, and more complete healing of the handsewn anastomosis.
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Read at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, April 29 to May 4, 1990.
This study was funded by Deknatel, A Division of Pfizer Incorporated, Fall River, Massachusetts.
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Dziki, A.J., Duncan, M.D., Harmon, J.W. et al. Advantages of handsewn over stapled bowel anastomosis. Dis Colon Rectum 34, 442–448 (1991). https://doi.org/10.1007/BF02049926
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DOI: https://doi.org/10.1007/BF02049926