Microsurgical intestinal anastomosis

Abstract

The present investigation examined the morphological and functional effects of different microsurgical suture materials and techniques for intestinal anastomosis in 220 Sprague-Dawley rats. Extramucous end-on and inverted anastomoses were performed using non-absorbable monofilament 7-0, 8-0, and 10-0 (metric 0.2) nylon (Ethilon), absorbable braided 8-0 polyglactin 910 (Vicryl), and monofilament 10-0 Vicryl. Both suture materials were swaged onto taper-point needles. The efficacy of the anastomoses was evaluated by measurement of bursting strength, the healing by light microscopic and scanning electron microscopic (SEM) examination, and revascularization by perfusion of India ink into the aorta. Non-inverting, single-layer, extramucous end-on intestinal anastomoses performed with microsurgical technique and micromonofilament suture material gave excellent results without complications, a bursting pressure superior to the inverting technique, rapid revascularization, and per primam healing. Thicker sutures were less favorable. The highest bursting strength was obtained in anastomoses performed using 10-0 Vicryl and 10-0 Ethilon. Fine absorbable sutures are thus the optimal material for intestinal anastomoses.